[Periampullar tumors: role of intraoperative color-Doppler ultrasonography in the evaluation of vascular invasion. Methods available to the surgeon and personal experience].
BACKGROUND
Tumors of the head of the pancreas and of the periampullary region, similar nosologic entity, represent the fourth most common cause of cancer death. These tumors are characterized bt high mortality rate associated with a low percentage of surgical resectability. Vascularly involvement is, in our experience, one of the criteria of exclusion for curative surgical resection. For this reason regional pancreasectomy don't show, in several case records, comforting datas about survival.


METHODS
From 1995 to 1998 we introduced in the operative practice the color--doppler ultrasonography to diagnose vasculary involvement. We evaluated twenty patients that previously were candidated for surgical therapy consisting in a duodenal-pancreasectomy. All the patients were staged by preoperative abdominal ultrasound, E.R.C.P., CT, and angio M.R.I.. In no one of these patients were founded signs of vascularly involvement. We recognized by intraoperative color-doppler ultrasound three microscopic invasions of spleno-mesenteric-portal vasculary axis.


RESULTS
U.S. I.O. C.D. in our case reports has underlined a sensibility and specificity of 100%. It has discovered, also, a false positive for neoplastic thrombosis, and a case of false negative.


CONCLUSIONS
Intraoperative ultrasound shows a high sensibility about the intraoperative staging for the bibliopancreatic tumors. The study about the possible vascularly involvement is helped by the application of the colour in terms of an high sensibility and diagnostic care.
Alberti
A
A
Policlinico Universitario G. Martino Istituto di Chirurgica Generale la Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Messina.
Dattola
A
A
Parisi
A
A
Maccarone
P
P
Dattola
P
P
Celi
S
S
Basile
M
M
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000601:surgery; D000792:Angiography; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*