What is the yield of intraoperative ultrasonography during partial hepatectomy for malignant disease?

BACKGROUND: Previous studies have shown that intraoperative ultrasonography (IOUS) duri ng hepatic resection for malignancy changes the operative plan or identifie s occult unresectable disease in a large proportion of patients. This study was undertaken to reassess the yield of IOUS in light of recent improvemen ts in preoperative staging. STUDY DESIGN: Patients with potentially resect able primary or metastatic hepatic maligna ncies subjected to exploration, bimanual palpation of the liver, and IOUS w ere evaluated prospectively. Intraoperative findings were recorded, and pre operative imaging studies were reanalyzed by radiologists blinded to the in traoperative findings. The extent of disease based on preoperative imaging was compared with the intraoperative findings. RESULTS: From October 1997 until November 1998, 111 patients were evaluated. At expl oration, a total of 77 new findings or findings different than suggested on the: imaging studies were identified in 61 patients (55%), the most common of which was additional hepatic tumors (n = 37). Thirty-five of 77 (45%) n ew findings were identified by IOUS alone and 10 (13%) by palpation alone; the remainder were identified by both palpation and IOUS. Forty-seven of 61 patients (77%) underwent a complete resect ion despite new intraoperative findings, with a modification (n = 28) or no change (n = 19) in the planned operation. Twenty-one patients (19%) had new findings identified only on I OUS. Thirteen of these patients underwent resection with no change in the o perative plan, six underwent a modified resection and two were considered t o have unresectable disease based solely on the findings of IOUS. CONCLUSIONS: In patients with hepatic malignancies submitted to a potentially curative r esection, new intraoperative findings or findings different than suggested on preoperative imaging studies are common. But resection with no change in the operative plan or a modified resection is still possible in the majori ty of patients despite such findings. The findings on IOUS alone rarely lea d to a change in dhe operative plan. (J Am Coll Surg 2001;192:577-583. (C) 2001 by the American College of Surgeons).