VALUE OF HIGH-RESOLUTION INTRAOPERATIVE ULTRASONOGRAPHY IN THE DETERMINATION OF LIMITS OF HORIZONTAL TUMOR SPREAD DURING SURGERY FOR GASTRIC MALIGNANCY

Determination of the resection margins during surgery for gastric mali gnancy is a subject of-controversy because accurate detection of horiz ontal limits of tumor spread is difficult by current methods. In this study, we investigated the value of intraoperative-ultrasonography (IU S) in the detection of proximal and distal limits of horizontal tumor spread (HTS) in 19 gastric adenocarcinoma (Group I) and five gastric l ymphoma (Group II) patients. After sonographic and clinical limits of HTS were marked, resections were carried out 2 cm away from the IUS li mits, and biopsies from IUS limits and resection margins were obtained . Then, the gap between IUS and clinical limits were recorded and comp ared with results of pathology. In both groups, the distance from clin ical to IUS limits ranged from 0 cm to 3 cm and IUS limits were never inside the clinical limits. In Group I, results of sonographic proxima l limit detection were satisfactory in all patients excluding recurren t cases (n:2) and a patient with early gastric cancer. Sonographic acc uracy of distal limit detection was 68%. In Group I, only one resectio n margin (distal) was found to be infiltrated with cancer. In Group II , the success rate of IUS-guided HTS detection was 40%. IUS seems to b e a valuable method for determining the extent of HTS during operation for gastric adenocarcinomas, especially so for the most problematic p roximal limits. In recurrent cancers and lymphomas, however, results o f IUS may be frequently misleading. IUS can be advocated as a routine procedure to determine the tumor limits and thus the resection margins during surgery for primary gastric adenocarcinomas. (C) 1995 Wiley-Li ss, Inc.