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01-10-2013 | Dynamic Manuscript

Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery

Authors: Joanna K. Law, Vikesh K. Singh, Mouen A. Khashab, Ralph H. Hruban, Marcia Irene Canto, Eun Ji Shin, Payal Saxena, Matthew J. Weiss, Timothy M. Pawlik, Christopher L. Wolfgang, Anne Marie Lennon

Published in: Surgical Endoscopy | Issue 10/2013

Abstract

Background

Parenchymal-sparing pancreatic surgery is ideal for lesions such as small pancreatic neuroendocrine tumors (PanNET). However, precise localization of these small tumors at surgery can be difficult. The placement of fiducials under endoscopic ultrasound (EUS) guidance (EUS-F) has been used to direct stereotactic radiation therapy for pancreatic adenocarcinoma. This report describes two cases in which placement of fiducials was used to guide surgical resection. This study aimed to assess the feasibility, safety, and efficacy of using EUS-F for intraoperative localization of small PanNETs.

Methods

A retrospective study analyzed two consecutive patients with small PanNETs who underwent EUS-F followed by enucleation in a tertiary-care referral hospital. The following features were examined: technical success and complication rates of EUS-F, visibility of the fiducial at the time of surgery, and fiducial migration.

Results

In the study, EUS-F was performed for two female patients with a 7-mm and a 9-mm PanNET respectively in the uncinate process and neck of the pancreas. In both patients, EUS-F was feasible with two Visicoil fiducials (Core Oncology, Santa Barbara, CA, USA) placed either within or adjacent to the tumors using a 22-gauge Cook Echotip needle. At surgery, the fiducials were clearly visible on intraoperative ultrasound, and both the tumor and the fiducials were successfully enucleated in both cases. No complications were associated with EUS-F, and no evidence of pancreatitis was shown either clinically or on surgical pathology. This investigation had the limitations of a small single-center study.

Conclusions

For patients undergoing enucleation, EUS-F is technically feasible and safe and aids intraoperative localization of small PanNETs.

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Mettler FA Jr, Thomadsen BR, Bhargavan M et al (2008) Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys 95:502–507PubMedCrossRef

Vagefi PA, Razo O, Deshpande V et al (2007) Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: the Massachusetts General Hospital experience from 1977 to 2005. Arch Surg 142:347–354PubMedCrossRef

Khashab MA, Kim KJ, Tryggestad EJ et al (2012) Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc 76:962–971PubMedCrossRef

Pishvaian AC, Collins B, Gagnon G et al (2006) EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 64:412–417PubMedCrossRef

Falconi M, Bartsch DK, Eriksson B et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic nonfunctioning tumors. Neuroendocrinology 95:120–134PubMedCrossRef

Smith JK, Ng SC, Hill JS et al (2010) Complications after pancreatectomy for neuroendocrine tumors: a national study. J Surg Res 163:63–68PubMedCrossRef

Falconi M, Mantovani W, Crippa S et al (2008) Pancreatic insufficiency after different resections for benign tumours. Br J Surg 95:85–91PubMedCrossRef

Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMedCrossRef

Mabrut JY, Fernandez-Cruz L, Azagra JS et al (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605PubMedCrossRef

10.

Ayav A, Bresler L, Brunaud L et al (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390:134–140PubMedCrossRef

11.

Wong M, Isa SH, Zahiah M et al (2007) Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma. World J Surg 31:586–592PubMedCrossRef

12.

Berends FJ, Cuesta MA, Kazemier G et al (2000) Laparoscopic detection and resection of insulinomas. Surgery 128:386–391PubMedCrossRef

13.

Farrell JJ, Sherrod A, Parekh D (2009) EUS-guided fine-needle tattooing for preoperative localization of early pancreatic adenocarcinoma. Gastrointest Endosc 69:176–177PubMedCrossRef

14.

Zografos GN, Stathopoulou A, Mitropapas G et al (2005) Preoperative imaging and localization of small sized insulinoma with EUS-guided fine-needle tattooing: a case report. Hormones Athens 4:111–116PubMed

15.

Ashida R, Yamao K, Okubo K et al (2006) Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors. Endoscopy 38:190–192PubMedCrossRef

16.

Newman NA, Lennon AM, Edil BH et al (2010) Preoperative endoscopic tattooing of pancreatic body and tail lesions decreases operative time for laparoscopic distal pancreatectomy. Surgery 148:371–377PubMedCrossRef

17.

Hackert T, Hinz U, Fritz S et al (2011) Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbecks Arch Surg 396:1197–1203PubMedCrossRef

18.

Dedieu A, Rault A, Collet D et al (2011) Laparoscopic enucleation of pancreatic neoplasm. Surg Endosc 25:572–576PubMedCrossRef

19.

Nikfarjam M, Warshaw AL, Axelrod L et al (2008) Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital. Ann Surg 247:165–172PubMedCrossRef

20.

Atema JJ, Amri R, Busch OR et al (2012) Surgical treatment of gastrinomas: a single-centre experience. HPB Oxford 14:833–838PubMedCrossRef

21.

Park WG, Yan BM, Schellenberg D et al (2010) EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc 71:513–518PubMedCrossRef

22.

Lennon AM, Newman N, Makary MA et al (2010) EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc 72:1089–1094PubMedCrossRef

Title: Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery
Authors: Joanna K. Law
Vikesh K. Singh
Mouen A. Khashab
Ralph H. Hruban
Marcia Irene Canto
Eun Ji Shin
Payal Saxena
Matthew J. Weiss
Timothy M. Pawlik
Christopher L. Wolfgang
Anne Marie Lennon
Publication date: 01-10-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2975-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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