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  • one patient was operated on twice Only included once br

    2019-11-11

    * one patient was operated on twice. Only included once.
    effect of IOUS assessment on surgical strategy and the information that Lycopene was provided based on the IOUS assess-ment are provided in Table 3. Example IOUS images corresponding to the findings are shown in Figure 1.
    Secondary outcome: Correlation with pathologic findings
    Resection was cancelled twice based on the IOUS assessment during surgical exploration. In addition, sur-gery was cancelled during a third procedure; however,  Volume 45, Number 8, 2019
    Table 2. Tumor characteristics off IOUS assessment
    Size (max diameter) measurable 22 71
    Origin and localization ampulla of Vater 3 10 of tumor distal bile duct 2 6
    duodenum 2 6
    proc. uncinatus 4 17
    diffuse 1 4 Vascular contact no vascular contact 16 52 of tumor contact with vessel 9 29
    involvement of vessel 5 16
    contact cannot be judged 1 3 Visibility clear 21 68
    moderate 6 19
    poor 4 13 Echogenicity hypoechoic 29 94
    isoechoic 2 6 Border distinct 12 39
    indistinct 19 61 Margin sharp 7 23
    IOUS = intraoperative ultrasound; IQR = interquartile range; proc. uncinatus = uncinated process.
    this decision was based on inspection followed by confir-mation of malignancy in a frozen section rather than on the IOUS assessment. In one case, the PA revealed a serous cystadenoma in the resected specimen instead of a malignant tumor. Thus, a total of 27 malignancies were resected, which are summarized in Supplementary Table S3. Of these 27 resected malignancies, 6 (22%) were R1, with the following resection margins involved: superior mesenteric artery (SMA) (n = 2 tumors), tumor growth in a resected segment of the SMV (n = 2), gastro-duodenal artery resection margin (n = 1) and both the pancreatic resection margin and the common bile duct margin (n = 1). The surgical strategy was influenced by the IOUS assessment in four of the patients with an R1 resection.
    Tertiary outcome: Comparison of the preoperative imaging, IOUS and PA assessments of vascular involvement
    Next, the results of the IOUS and final PA assess-ment for the 27 resected malignancies with respect to any vascular involvement were compared. Specifically, the tumor contact with the SMV or SMA resection mar-gins as assessed by microscopic examination was com-pared with both the preoperative imaging and the IOUS assessment; these results are summarized in Table 4. In four patients, the vascular contact could not be assessed
    Intraoperative US for pancreatic cancer B. G. SIBINGA MULDER et al.
    2023 Table 3. Influence of IOUS on surgical strategy
    Tumor localization 8 26%
    Identification of lesions with IOUS compared 4
    with preoperative diagnostics
    One malignant lesion was retrieved 2
    with IOUS, instead of multiple lesions
    An additional or larger lesion was 2
    retrieved, leading to total pancreatectomy
    Determination of resection margin 4
    Based on location of tumor, a duodenal, 2
    PPPD or tail resection was performed
    After neoadjuvant therapy and 2
    preoperative scan could suboptimally
    be judged
    Vascular involvement 9 29%
    Vascular contact during IOUS was more 4
    extensive than on preoperative scan, leading
    to vascular reconstruction
    Vascular contact on preoperative scan was 4
    suboptimal but visible with IOUS
    Vascular contact on preoperative scan was not 1
    present during IOUS
    Resection waived 2 6%
    Because of extensive vascular contact during 2
    IOUS synaptic cleft was not present on the preoperative scan
    and histopathologically confirmed by a frozen section