In this thesis the additional value of targeted Next-Generation Sequencing was described in order to optimize the diagnostic process of patients with a suspect pancreatic lesion. Furthermore,... Show moreIn this thesis the additional value of targeted Next-Generation Sequencing was described in order to optimize the diagnostic process of patients with a suspect pancreatic lesion. Furthermore, several imaging techniques are described to visualize pancreatic cancer or colorectal liver metastases prior to surgery and during surgery. By better visualization of the tumor extent optimal treatment plans can be proposed and radical resections can be accomplished. Show less
Surgical exploration in patients with pancreatic or periampullary cancer is often performed without intraoperative image guidance. Although intraoperative ultrasound (IOUS) may enhance... Show moreSurgical exploration in patients with pancreatic or periampullary cancer is often performed without intraoperative image guidance. Although intraoperative ultrasound (IOUS) may enhance visualization during resection, this tool has not been investigated in detail until now. Here, we performed a prospective cohort study to evaluate the effect of IOUS on surgical strategy and to evaluate whether vascular involvement and radicality of the resection could be correctly assessed with IOUS. IOUS was performed by an experienced abdominal radiologist during surgical exploration in 31 consecutive procedures. IOUS affected surgical strategy by either (i) having no effect, (ii) determining tumor localization, (iii) evaluating vascular involvement or (iv) waiving surgery. Radicality of the resections and vascular contact were determined during pathologic analysis and compared with preoperative imaging and IOUS findings. Overall, IOUS influenced surgical strategy in 61% of procedures. In 21 out of 27 malignant tumors, a radical resection was achieved (78%). Vascular contact was assessed correctly using IOUS in 89% compared with 74% of patients using preoperative imaging. IOUS can help the surgical team to assess the resectability and to visualize the tumor and possible vascular contact in real time during resection. IOUS may therefore increase the likelihood of achieving a radical resection. (C) 2019 World Federation for Ultrasound in Medicine & Biology. All rights reserved. Show less
