Preoperative Volume Rendering Can Pervent Intraoperative Surprises and Post Operative Catastrophe for Pancreaticodudenectomy = Preoperative Volume Rendering Can Pervent Intraoperative Surprises and Post Operative Catastrophe for Pancreaticodudenectomy

다국어 초록 (Multilingual Abstract)

Aims: Pancreatic adenocarcinoma is one the leading cause of cancer related deaths all over the world. Pancreaticoduodenectomy is a complex surgical procedure used to resect tumours of the head of the pancreas, distal common bile duct, and duodenum. There is considerable anatomic variability in the arterial supply to this region and preoperative knowledge of the variants is important. Aim : The purpose of this study was to determine the benefit of preoperative Volume Rendering in predicting the arterial variants that cross the anticipated surgical resection plane in pancreaticoduodenectomy.
Methods: Retrospective analysis of prospectively maintained database of 137 patients who underwent pancreaticoduodenectomy with preoperative CT abdomen with 64-MDCT over a period of 3 years. 3D Volume Rendering, Maximum Intensity Projection and Multiplanar Reconstruction were used for evaluation to determine anatomical variation.
Results: Out of 137 patients, 27 patients (20%) had replaced Right Hepatic artery, 14 patients (10%) had Accessory Right Hepatic artery, 1 patient (0.73%) with rare variants where common hepatic artery and superior mesenteric artery were arising from the common trunk, 1 patient (0.73%) Common Hepatic artery arising from Superior Mesenteric artery and 1 patient (0.73%) with accessory right and left hepatic artery..
Conclusions: Preoperative three dimensionally constructed MDCT images have been found to prevent the intraoperative surprises and post operative catastrophic complications faced by the surgeons due to aberrant vascular anatomy in pancreaticodudenectomy. The study highlights the incidence of arterial variations encountered in patients of pancreatic malignancy who underwent pancreaticoduodenenctomy.