Evaluation the use of intraoperative ultrasonography during hepatobiliary and pancreatic surgery

O objetivo do presente trabalho foi avaliar o valor diagnóstico e o impacto na modificação da conduta terapêutica do ultra-som intra-operatório (UIO) na cirurgia por neoplasia de fígado, vias biliares e pâncreas, comparando-se achados da avaliação pré-operatória de rotina com métodos de imagem convencionais (tomografia computadorizada e ressonância magnética) com achados obtidos por meio da exploração cirúrgica (inspeção e palpação). Foram analisados, retrospectivamente, exames realizados em 49 pacientes, sendo 15 portadores de neoplasia hepática secundária; 14, de neoplasia hepática primária; 14, de tumor neuroendócrino pancreático e seis de neoplasia cística pancreática. No grupo de pacientes com neoplasia hepática e de vias biliares, a TC identificou 65% dos tumores; a exploração cirúrgica, 69,5% e o UIO, 95,2%. Houve mudança da conduta, em decorrência dos achados do UIO, em 34,4% dos pacientes. No grupo de tumores neuroendócrinos pancreáticos, a TC identificou corretamente 44,4% dos tumores; a RM, 60,9%; a exploração cirúrgica com palpação, 72,7% e o UIO, 100%. Houve mudança de conduta em 42,9% dos pacientes. No grupo de neoplasia cística, o UIO não acrescentou informação adicional relevante em relação à TC e à RM, exceto no paciente com neoplasia papilífera intraductal. Apesar do grande avanço nos métodos de avaliação por imagem pré-operatórios e mesmo com toda a expertise do cirurgião, os resultados mostram que o UIO modifica positivamente o planejamento cirúrgico em um número significativo de pacientes, devendo, portanto fazer parte integrante da avaliação intra-operatória dos pacientes candidatos à ressecção hepática por neoplasia primária ou secundária e da cirurgia de neoplasia endócrina pancreáticaIntraoperative sonography (IOU) is an imaging modality that has been showing rapid growth in the last decade that can has a variety of applications in different surgical specialities, particularly in abdominal surgery. The purpose of this study was to analyze the use o IOU in the setting of surgery for liver, biliary and pancreatic malignancies. To achieve that, the findings of routine preoperative state-of the-art imaging modalities (CT and MRI) and the findings of surgical exploration (inspection and palpation) were compared to those of IOU. The impact of IOU on preoperative plans based on CT and MRI and on management after surgical exploration were studied as well 49 patients were retrospectively studied. Of those 15 had metastatic liver disease and 14 primary liver cancer; 14 had pancreatic neuroendocrine tumours and 6 had cystic pancreatic neoplasms. In the group of hepatic and biliary malignancies CT identified 65% of the tumours, surgical exploration identified 69.5% and IOU 95.2% (including 3 false positives). IOU determined a change in management in 34.4% of the patients. In the group of pancreatic neuroendocrine tumours the rates of identification were 27.3% for CT, 60.9% for MRI, 72.7% for surgical exploration and 100% for IOU, with an alteration in surgical plans in 42.9% of patients after IOU. In the case of patients with cystic pancreatic neoplasia, IOUS did not add any relevant additional information in relation to CT or MRI, with exception to one patient that had a papiliferous intraductal neoplasia. In spite of the great advances on preoperatory imaging modalities and of the possibility of direct surgical exploration, IOU has shown that it positively modifies surgical planning. For that reason, it should be included as an essential adjunct in the intraoperatory evaluation of patients with pancreatic endocrine neoplasia and of candidates for hepatic resection in cases of primary and secondary malignancie