ULTRASONOGRAPHY DURING LIVER RESECTION FOR HEPATOCELLULAR-CARCINOMA

Seventy-nine consecutive patients underwent elective laparotomy for sy mptomatic hepatocellular carcinoma between 1986 and 1992. In the first 4 years, 51 patients received liver resection without intraoperative ultrasonography. In the subsequent 2 years, ultrasonography was perfor med during operation on 28 patients; three were found to have inoperab le tumours. The technique located tumours in two patients and changed the extent of liver resection in another two. Eight of 51 patients (16 per cent) who had the parenchymal transection plane determined clinic ally had histological evidence of tumour infiltration of the resection margins, compared with none of 25 in whom the plane was determined by ultrasonography. This difference was significant (P = 0.034). The use of intraoperative ultrasonography improved patient survival, although this was not statistically significant. The median survival of patien ts with adequate resection margins was 9.2 months, compared with 3.9 m onths in those with inadequate margins. Intraoperative ultrasonography is useful in surgery for hepatocellular carcinoma.