DOES INTRAOPERATIVE HEPATIC ULTRASONOGRAPHY CHANGE SURGICAL DECISION-MAKING DURING LIVER RESECTION

BACKGROUND: Intraoperative hepatic ultrasonography (IOUS) has been use d to accurately identify and localize hepatic tumors as an adjunct to hepatic resection and for the detection of occult liver metastases dur ing primary resection of other gastrointestinal carcinomas. The face v alidity of IOUS to identify more lesions than conventional diagnostic modalities and the content validity of IOUS to change the planned surg ical management has been assessed in a blinded, prospective manner. ME THODS: Sixty-two patients were studied at two institutions by one surg eon. IOUS ws compared with computed tomography (CT) angioportography i n 30 patients undergoing planned hepatic resection (19 metastatic, 11 primary) and with conventional hepatic ultrasonography (+/- venous enh anced CT scan) in 32 patients undergoing primary excision of gastroint estinal carcinomas. RESULTS: Twenty of the 30 hepatic resections (67%) were changed or guided by IOUS as determined by the operating surgeon at the completion of the laparotomy. IOUS detected 26 more metastases (44%) in 10 of 19 patients (1 to 5 per patient). Two patients had pre operatively suspected metastases refuted by IOUS-guided biopsy. Eight of the 11 patients (73%) undergoing resection of primary carcinoma of the liver had the planned procedure changed or guided by IOUS. This in cluded four hepatocellular carcinomas with more extensive involvement at the confluence of the hepatic veins and the inferior vena cave, nec essitating resection with the aid of total vascular isolation. In 32 p atients undergoing primary resection of gastrointestinal carcinomas, 5 patients (16%) had the stage of disease altered by IOUS when compared with conventional ultrasound (+/- venous enhanced CT scan). CONCLUSIO NS: The validity of IOUS is good. IOUS guided the intraoperative surgi cal management of two thirds of the patients undergoing hepatic resect ion when compared with CT angioportography. Intraoperative hepatic ult rasonography using a reproducible systematic approach can change the c linical management of patients undergoing hepatic resection for malign ancy.