EUS-guided tattooing before laparoscopic distal pancreatic resection (with video) - 24/08/11
, Naeem Newman, MD , Martin A. Makary, MD, MPH, Barish H. Edil, MD, Eun Ji Shin, MD, Mouen A. Khashab, MD, Ralph H. Hruban, MD, Christopher L. Wolfgang, MD, PhD, Richard D. Schulick, MD, FACS, Samuel Giday, Marcia I. Canto, MD, MHS ⁎Reprint requests: Marcia Irene Canto, MD, MHS, Johns Hopkins University, Division of Gastroenterology, 1830 East Monument Street, Room 427, Baltimore, MD 21205Résumé |
Background |
Precise localization of small pancreatic tumors during laparoscopic distal pancreatectomy (LDP) can be difficult because of decreased tactile ability of laparoscopy and the homogeneous appearance of the pancreas and surrounding retroperitoneal fat. Precise localization of the lesion is critical to achieving adequate margins of resection and preserving healthy pancreatic tissue. EUS-guided fine-needle tattooing (EUS-FNT) of a pancreatic lesion before LDP has been described in single case reports, but no large series have reported its effectiveness in patients undergoing LDP.
Objective |
To assess the feasibility, safety, and efficacy of EUS-FNT in consecutive patients undergoing LDP.
Design |
Retrospective cohort study.
Setting |
Tertiary-care referral hospital.
Patients |
This study involved 30 consecutive patients who underwent LDP from 2008 to 2010. Thirteen had EUS-FNT followed by LDP, and 17 had LDP alone.
Interventions |
LDP or EUS-FNT with a sterile carbon-particle tattoo followed by LDP.
Main Outcome Measurements |
The following features were examined: the technical success and complication rates of EUS-FNT, visibility of the tattoo at the time of laparoscopy, durability of the tattoo, and pathologic absence of tumor at the resection margin.
Results |
The final pathology of pancreatic lesions of patients who had EUS-FNT was similar to those who had LDP alone. The median resected tumor size was significantly larger for the LDP-alone patients (median 4.0 cm vs 1.3 cm; P = .03). Thirty-one percent (4/13) of lesions in the EUS-FNT group were not visualized by prior preoperative pancreatic protocol CT. EUS-FNT was feasible in all 13 patients at laparoscopy, with R0 resection and negative final pathology margins in all cases. The tattoo was visible in all 13 EUS-FNT cases, with mean time from EUS-FNT to surgery of 20.3 days (range, 3-69 days). There were no significant complications associated with EUS-FNT.
Limitations |
Small, retrospective, single-center study.
Conclusions |
Preoperative EUS-FNT of lesions was technically feasible and safe, and it assisted in the localization of lesions in patients before LDP. The carbon particle tattoo was durable and visible in all cases.
Le texte complet de cet article est disponible en PDF.Abbreviations : EUS-FNT, EUS-FNA, LDP
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 72 - N° 5
P. 1089-1094 - novembre 2010 Retour au numéro
Article précédent
- Pancreatic antegrade needle-knife (PANK) for treatment of symptomatic pancreatic duct obstruction in Whipple patients (with video)
- Marvin Ryou, Daniel K. Mullady, Christopher J. Dimaio, Richard S. Swanson, David L. Carr-Locke, Christopher C. Thompson
- Infectious spondylodiscitis caused by esophageal injury after blunt chest trauma
- Seon-Young Park, Hae-Kyung Chung, Kyoung-Won Yoon, Sook-In Jung, Chang-Hwan Park, Young-Eun Joo, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?