title: Intraoperative ultrasonography in pancreatic surgery: staging and resection guidance.
abstract: BACKGROUND
  Intraoperative ultrasound examination (IOUS) is indispensable part of modern surgical interventions in tumors of hepatopancreatobiliary zone. In this study retrospective analysis of IOUS efficiency in surgical treatment of pancreatic tumors was provided.
  
  
  METHODS
  In the period from January 2013 till November 2015 in the National Cancer Institute IOUS was applied during 76 surgical interventions: for pancreatic head tumors--in 46 (60.5%) patients, for body/tail pancreatic tumors--in 20 (26.3%) patients, in 10 (13.2%) patients--for periampullary zone neoplasms. In IOUS we performed primary tumor assessment (localization, degree of tumor spreading to superior mesenteric vessels, hepatoduodenal ligament vessels, additional foci occurrence in pancreas), and liver metastases detection. Surgical interventions were performed: pancreatoduodenectomy in 52 (68.4%) patients, radical antegrade modal pancreatosplenectomy--in 14 (18.4%) patients.
  
  
  RESULTS
  IOUS allowed determining additional tumor foci in pancreas in 2 (2.6%) patients, in 8 (10.5%) observations tumor invasion into portal or superior mesenteric vein was determined. In 21 (27.6%) patient additional hepatic neoplasms were detected (in half of cases--11.8%, metastases). These findings resulted in change of surgical intervention extent in 23 (30.3%) patients: expansion to combined resections in 14 (18.4%) patients, reduction to symptomatic operations in 5 (6.6%) cases, organ-preserving operations were performed in 4 (5.3%) patients. Variant anatomy of hepatic arterial blood supply was determined in 41 (53.9%) patients that necessitated performance correction of resection stages for preservation of adequate hepatic blood supply.
  
  
  CONCLUSIONS
  IOUS is a highly-precise diagnostic method substantively influencing operation course in pancreatic tumors, enabling surgeon to provide adequate staging and permanent correction of operation course.
authors.affiliation: National Cancer Institute, Kyiv 03025, Ukraine.
authors.forename: O
authors.initials: O
authors.lastname: Kolesnik
authors.affiliation: National Cancer Institute, Kyiv 03025, Ukraine.
authors.forename: A
authors.initials: A
authors.lastname: Lukashenko
authors.affiliation: National Cancer Institute, Kyiv 03025, Ukraine.
authors.forename: A
authors.initials: A
authors.lastname: Shudrak
authors.affiliation: National Cancer Institute, Kyiv 03025, Ukraine.
authors.forename: T
authors.initials: T
authors.lastname: Golovko
authors.affiliation: National Cancer Institute, Kyiv 03025, Ukraine.
authors.forename: G
authors.initials: G
authors.lastname: Lavryk
authors.affiliation: National Cancer Institute, Kyiv 03025, Ukraine.
authors.forename: J
authors.initials: J
authors.lastname: Huralevych
mesh_terms: D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods