An Important Adjunctive Tool for Decision Making in the Operating Room

Rifkin, Matthew D.; Rosato, Francis E.; Branch, Hira E.; Foster, Jonathan; Yang, Shuin-Lin; Barbot, Donna J.; Marks, Gerald

doi:10.1097/00000658-198705000-00004

Cited by 104 publications

(38 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3,4,12,18 While there was a historical decrease in rates between decades, our study results confirm that the impact of IOUS has plateaued over the last decade despite further advances in preoperative imaging. With the current rates of change in surgical strategy, it appears that modern preoperative imaging alone does not preclude the use of IOUS.…”

Section: Discussionsupporting

confidence: 70%

Intraoperative ultrasonography and surgical strategy in hepatic resection: What difference does it make?

2015

View full text Add to dashboard Cite

Background: With modern advancements in preoperative imaging for liver surgery, intraoperative ultrasonography (IOUS) may be perceived as superfluous. Our aim was to determine if IOUS provides new information that changes surgical strategy in hepatic resection. Methods:We retrospectively analyzed 121 consecutive liver resections performed at a single institution. Preoperative computed tomography and/or magnetic resonance imaging determined the initial surgical strategy. The size, location and number of lesions were compared between IOUS and preoperative imaging. Reviewing the operative report helped determine if new IOUS findings led to changes in surgical strategy. Pathology reports were analyzed for margins. Results:Of 121 procedures analyzed, IOUS was used in 88. It changed the surgical plan in 15 (17%) cases. Additional tumours were detected in 10 (11%) patients. A change in tumour size and location were detected in 2 (2%) and 3 (4%) patients, respectively. Surgical plans were altered in 7 (8%) cases for reasons not related to IOUS. There was no significant difference (p = 0.74) in average margin length between the IOUS and non-IOUS groups (1.09 ± 1.18 cm v. 1.18 ± 1.05 cm). Conclusion:Surgical strategy was altered owing to IOUS results in a substantial number of cases, and IOUS-guided resection planes resulted in R0 resections in nearly all procedures. The best operative plan in hepatic resection includes IOUS. Contexte :Compte tenu des récentes avancées de l'imagerie préopératoire pour les chirurgies du foie, l'utilisation de l'échographie peropératoire pourrait paraître inutile. Notre objectif était de déterminer si cette pratique permet d'obtenir des images nouvelles motivant un changement de stratégie chirurgicale pendant une résection hépatique.Méthodes : Nous avons analysé rétrospectivement 121 résections hépatiques consé-cu tives réalisées dans un même établissement. La tomographie par ordinateur ou l'imagerie par résonance magnétique préopératoires ont été utilisées pour choisir la stratégie chirurgicale initiale. La taille et la position des tumeurs détectées ainsi que leur nombre ont été comparés selon la méthode utilisée : échographie peropératoire ou imagerie préopératoire. Nous avons étudié les rapports opératoires pour déter-miner si l'échographie peropératoire avait entraîné un changement de stratégie chirurgicale et avons examiné les rapports de pathologie pour connaître les résultats de l'analyse des contours.Résultats : L'échographie peropératoire a été utilisée dans 88 des 121 interventions étudiées. Elle a influé sur la stratégie chirurgicale dans 15 cas (17 %). De nouvelles tumeurs ont été détectées chez 10 patients (11 %), et un changement dans la taille ou la position de la tumeur a été détecté chez 2 (2 %) et 3 patients (4 %), respectivement. Dans 7 cas (8 %), la stratégie chirurgicale a été modifiée, mais pour des raisons indépendantes des résultats de l'échographie. Nous n'avons pas observé de différence significative (p = 0,74) entre la taille moyenne des contours pour les 2 group...

show abstract

Section: Discussionsupporting

confidence: 70%

Intraoperative ultrasonography and surgical strategy in hepatic resection: What difference does it make?

2015

View full text Add to dashboard Cite

show abstract

“…[13][14][15][16][17] Despite the rapid development and improvement of CT and MRI, IOUS still has a significant impact on the surgical technique of choice. 18 With the introduction of PET, the value of IOUS has been challenged.…”

mentioning

confidence: 99%

Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Wildi

Gubler

Hany

et al. 2007

J of Clinical Ultrasound

View full text Add to dashboard Cite

Background. Combined fluorine 18-fluorodeoxyglucose-positron emission tomography-CT imaging has been shown to be of good diagnostic value in the preoperative evaluation of patients with colorectal cancer and liver metastases. The adjunctive use of intraoperative sonography (IOUS) may have a limited impact on treatment selection in these patients.Purpose. To compare the diagnostic performance of preoperative positron emission tomography (PET)-CT alone and PET-CT combined with IOUS in the evaluation of patients who are considered for curative resection of hepatic metastases from colorectal carcinoma.Materials and Methods. Patients with colorectal cancer who underwent resection of hepatic metastases and preoperative PET-CT (with or without contrast-enhanced CT) and IOUS were identified. The performance of the imaging techniques was evaluated through review of the radiologic reports, correlation with surgical and histopathologic findings, and clinical follow-up.Results. Thirty-one patients (mean age, 63.5 years [range, 53-82 years]) were analyzed. Fifteen patients had received preoperative chemotherapy. The mean interval between PET-CT and IOUS was 22.6 days (range, 1-56 days). In 4 cases, neither PET-CT nor IOUS correctly diagnosed the liver metastases. In all 31 patients, the sensitivity of PET-CT alone and PET-CT combined with IOUS was 63% (95% CI 44-80%) and 93% (95% CI 78-98%), respectively; the positive predictive value was 81% and 89%, respectively. In patients without preoperative chemotherapy (n 5 16), the sensitivity of PET-CT alone and PET-CT combined with IOUS was 77% (95% CI 49-94%) and 100% (95% CI 79-100%), respectively. In 11 cases (35%), IOUS altered the surgical strategy.Conclusion. In patients with colorectal carcinoma and potentially resectable liver metastases on preoperative PET-CT, IOUS can provide additional information that may alter decision making with regard to surgical technique. Keywords: colorectal cancer; liver metastases; intraoperative sonography; FDG-PET-CT C olorectal cancer is the second leading cause of cancer-related death in the western hemisphere. Up to 70% of patients with colorectal cancer eventually develop liver metastases. In 30-40% of these patients, metastases are confined to the liver at the time of detection. Hepatic resection is the only therapeutic strategy that offers a chance of cure. In patients who undergo successful hepatic resection with curative intent, the expected 5-year survival rate is approximately 33%, and the 5-year disease-free survival rate is 22%. 1 A large number of patients develop intraor extrahepatic tumor recurrence after curative

show abstract

“…Additionally, some patients were hemodynamically unstable during surgery and careful IOUS exam was not possible in those dogs. IOUS of the liver in people requires an additional 10-15 minutes of operating time (RIFKIN et al, 1987). IOUS-guided-biopsy of all new lesions also increases the surgical time, making it difficult in unstable patients who require a faster procedure.…”

Section: Discussionmentioning

confidence: 99%

“…IOUS-guided-biopsy of all new lesions also increases the surgical time, making it difficult in unstable patients who require a faster procedure. This limitation could be decreased with an experienced intraoperative sonographer (RIFKIN et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect

Silva

Vieira

et al. 2017

Cienc. Rural

View full text Add to dashboard Cite

Intraoperative ultrasonography (IOUS) is used in medicine for diagnosis and guidance during oncologic surgery. The aims of this study were to assess the performance, feasibility, advantages and difficulties of the IOUS technique in dogs with suspected intra-abdominal tumors. The study included nine client-owed dogs that had suspected intra-abdominal tumors (spleen, liver or bowel) based on transabdominal ultrasound examination and that were subsequently referred for exploratory laparotomy surgery. During surgery, IOUS was performed; results of preoperative transabdominal ultrasonography, inspection by the surgeon and IOUS were compared on a case-by-case basis. IOUS was helpful in determining lesion resection in all cases. Lesions detected solely by the use of IOUS were observed in seven out of nine cases. Analysis of these cases demonstrated that IOUS can be a tool to assist during oncology surgery on the liver, spleen or bowel. Dogs with hepatic tumors can have small non-palpable intraparenchymal nodules, which may be visible by IOUS.

show abstract

An Important Adjunctive Tool for Decision Making in the Operating Room

Cited by 104 publications

References 11 publications

Intraoperative ultrasonography and surgical strategy in hepatic resection: What difference does it make?

Intraoperative ultrasonography and surgical strategy in hepatic resection: What difference does it make?

Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect

Contact Info

Product

Resources

About