Pancreatic Surgery: A Multidisciplinary Assessment of the Value of Intraoperative US

Abstract

To assess the value of intraoperative ultrasonography (US) for different types of pancreatic surgery. An institutional review board-approved, HIPAA-compliant retrospective review with waiver of informed consent was performed to evaluate all cases of pancreatic surgery with intraoperative US or laparoscopic US that occurred at a single institution during a 10-year period. Surgical notes, radiologic images, and clinical data for each surgical procedure and subsequent clinical course were reviewed by pancreatic surgeons and radiologists. Presumptive diagnosis, type of surgical procedure performed, and final pathologic data were recorded. A relative value score was established by consensus and assigned to each case with a grade of 0-3, which indicated the value of the intraoperative or laparoscopic US. The type of operation and pathologic data were compared in each of the value score groups. Categoric variables were compared by using either χ(2) or Fisher exact test. One hundred ninety-three intraoperative or laparoscopic US procedures were performed in 189 patients. Of the patients, there were 102 men and 87 women. The mean age was 57.8 years (range, 18-86 years). Intraoperative or laparoscopic US value scores were as follows: value score 0, 3.6%; value score 1, 11.9%; value score 2, 31.1%; and value score 3, 53.4%. The most common contribution that resulted in a high score (value score 3) was facilitation of technical performance of the surgery (n = 60). High value score was significantly associated with performance of pancreatitis-related surgery (P < .001). The surgical indication that most commonly resulted in a low value score of 0 or 1 was staging of pancreatic cancers. All cases that received a score of 0 occurred in the laparoscopic adenocarcinoma surgical setting (staging or pancreatic biopsy). Intraoperative or laparoscopic US can be a valuable procedure in multiple types of surgical procedures that involve the pancreas and shows clear patterns of value in the different types of surgery.