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

Study Overview
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Brief Summary
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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
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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

Official Title
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Three-Dimensional Vascular Reconstruction of the Pancreas on Multidetector Computed Tomography Images and Its Impact on Patients Undergoing Pancreaticoduodenectomy - A Prospective Observational Study

Conditions
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Pancreaticoduodenectomy

Intervention / Treatment
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* Procedure: Pancreaticoduodenectomy


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Consecutive adult patients undergoing pancreaticoduodenectomy<br>All the consecutive patients who undergo pancreaticoduodenectomy will be recruited into the study after obtaining informed consent | Procedure: Pancreaticoduodenectomy<br>* In Pre Operative phase 64 Slice MD CT scan will be taken in all patients undergoing PD in pre op period 3D reconstruction of Peripancreatic vascular system using MDCT images Measure longitudinal distance between Root of Left renal vein, origin of IPDA Measure distance between origin of SMA , MCA and the IPDA In Intraoperative period Distance will be measured using standard disposable ruler from Root of Left renal vein to IPDA after Transection of Pancreas followed by specimen removal and to measure the distance between MCA, SMA and IPDA using standard disposable ruler .<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 distance will be measured between root of Left Renal vein to Origin of IPDA | During the Procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 distance will be measured between Origin of SMA and MCA to Origin of IPDA | During the Procedure | 
| To correlate the early ligation of IPDA with Blood Loss and Operative time | Blood Loss during the procedure and time required to complete the pancreaticoduodenectomy procedure | During the Procedure | 
| Spectrum of arterial anomalies encountered during Pancreaticoduodenectomy | Anatomy of vascular arcades arising from the celiac and superior mesenteric arteries will be noted during the procedure | During The Procedure | 
| 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 | Operative time of patients who have undergone pancreaticoduodenectomy during the study period is compared with historical cohorts | During the Procedure | 
| 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 | Blood loss of patients who have undergone pancreaticoduodenectomy during the study period is compared with historical cohorts | During the Procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Inferior Pancreaticoduodenal artery, Multi detector Computed Tomography