Three-Dimensional Vascular Reconstruction of the Pancreas on Multidetector Computed Tomography Images and Its Impact on Patients Undergoing Pancreaticoduodenectomy

• Conditions: Pancreaticoduodenectomy
• Interventions: Procedure: Pancreaticoduodenectomy

• Registration Number: NCT05389917
• Lead Sponsor: Institute of Liver and Biliary Sciences, India

Brief Summary

Three-Dimensional Vascular Reconstruction of the Pancreas on Multi detector Computed Tomography images and its impact on patients undergoing Pancreatoduodenectomy - A Prospective Observational Study IPDA is difficult to identify in pre op in routine CECT images IPDA is difficult to identify in intra op Identification of those major blood vessels (SMA, MCA, Left Renal vein) that lie around the IPDA and then to measure the distances between these major vessels and the IPDA, helps to determine the location of the IPDA

Detailed Description

Pancreaticoduodenectomy (PD) is a complex surgical procedure performed for benign and malignant indications .

Vascular anatomy of the pancreatic head, is important in multiple aspects

* Classical arterial anatomy is observed in 55-79% of cases

* Arterial Variation is observed in around 25-30% of cases

* Relationship of the tumor to the blood vessels determines the resectability of tumor The presence of anatomical variations may increase the risk of complications through

* direct (bleeding due to intraoperative vessel injury)

* indirect (postoperative ischemia of tissues and anastomotic leakage) Preoperative understanding of the vascular anatomy of the pancreatic head is important in order to reduce intraoperative bleeding.

* IPDA is difficult to identify in pre op in routine CECT images. It is identified in only 20% of patients.

* IPDA is difficult to identify in intra op because- It generally originates from the posterior wall of superior mesenteric artery (SMA).The origin of IPDA frequently varies, which makes it difficult to identify in some patients. It is surrounded by dense lymphovascular tissue, which makes it difficult to identify IPDA during surgery.

IPDA can be identified in up to 86% of the time using 3D MDCT . Identification of those major blood vessels (SMA, MCA, Left Renal vein) that lie around the IPDA and then to measure the distances between these major vessels and the IPDA, helps to determine the location of the IPDA.

In the existing studies, they have not defined the impact of identifying IPDA on intra operative parameters ( Operative time, Blood loss) These studies have not used uniform landmarks in the identification of IPDA

Study Timeline

• Status Verified: 2022-05
• Study First Submitted: 2022-05-09
• Study First Submitted QC: 2022-05-21
• Last Update Submitted: 2022-05-21
• Study First Posted: 2022-05-25
• Last Update Posted: 2022-05-25
• Study Start: 2022-05-30
• Primary Completion: 2023-06-01
• Study Completion: 2023-06-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 25

Inclusion Criteria

• Consecutive Patients undergoing pancreaticoduodenectomy during the study period at ILBS

Exclusion Criteria

• If surgery is not proceeded for any cause like Presence of metastasis, Unreconstructable portal or SMV involvement , SMA involvement of >180 degree
• Refusal for consent

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Consecutive adult patients undergoing pancreaticoduodenectomy	Pancreaticoduodenectomy	All the consecutive patients who undergo pancreaticoduodenectomy will be recruited into the study after obtaining informed consent

Primary Outcome Measures

Name	Time	Method
Probability of identifying IPDA with in 1 cm of anticipated location from Left renal vein determined by preoperative 3D reconstructed MDCT images.	During the Procedure	During the procedure distance will be measured between root of Left Renal vein to Origin of IPDA

Secondary Outcome Measures

Name	Time	Method
To compare operative time between patients who undergo pre operative 3D vascular reconstruction on MD CT followed by Pancreaticoduodenectomy versus historical controls who have undergone pancreaticoduodenectomy at ILBS	During the Procedure	Operative time of patients who have undergone pancreaticoduodenectomy during the study period is compared with historical cohorts
To compare blood loss between patients who undergo pre operative 3D vascular reconstruction on MD CT followed by Pancreaticoduodenectomy versus historical controls who have undergone pancreaticoduodenectomy at ILBS	During the Procedure	Blood loss of patients who have undergone pancreaticoduodenectomy during the study period is compared with historical cohorts
To correlate the location of IPDA predicted by 3D reconstruction of preoperative MDCT images with actual intraoperative location of MCA and SMA, after specimen removal	During the Procedure	During the procedure distance will be measured between Origin of SMA and MCA to Origin of IPDA
To correlate the early ligation of IPDA with Blood Loss and Operative time	During the Procedure	Blood Loss during the procedure and time required to complete the pancreaticoduodenectomy procedure
Spectrum of arterial anomalies encountered during Pancreaticoduodenectomy	During The Procedure	Anatomy of vascular arcades arising from the celiac and superior mesenteric arteries will be noted during the procedure