Operative ultrasound establishes resectability of metastases by major hepatic resection

Abstract

In this study, the utility of intraoperative ultrasound in the surgical management of hepatic colorectal metastases requiring hepatic resection has been demonstrated. The intraoperative ultrasound technique has been described as a method to accurately monitor curative resection of large colorectal metastases requiring anatomical procedures such as right hepatic trisegmentectomy, bisegmentectomy, and hepatic lobectomy. Preoperative analysis of the patients reported utilizing either computed tomography, ultrasound, or magnetic resonance imaging demonstrated very well the extent of tumor but could not define a major anatomical resection along normal tissue planes. In the 3 patients demonstrated, intraoperative ultrasound was able to confirm a normal hepatic parenchymal dissection overlying the extensive tumors and enabled completion of the curative resections. Furthermore, we have described the intraoperative ultrasound criteria for assessment of resectability. These included a definition of the proximity of the major portal and hepatic venous structures, exclusion of simultaneous minimal metastatic disease in the remaining parenchyma, and the distinction between marginal resectability and resectability for cure along the proposed parenchymal dissection plane. We conclude that intraoperative ultrasound is important in the surgical management of metastatic colorectal cancer and can provide for a more complete clinical staging and appropriate selection of patients for curative major hepatic resection.

Operative ultrasonography during hepatobiliary and pancreatic surgery

“…During operation for malignant diseases, OUS helps to evaluate the tumor spread and thereby determine tumor staging. The resectability of tumor can be determined, and the most appropriate surgical operation can be decided at an early stage of the operation [5,7,[10][11][12][13]. Previously planned surgical procedures are changed on the basis of operative ultrasound findings.…”

“…A number of reports describing the value and indications of OUS during hepatobiliary and pancreatic surgery have been published [10][11][12][13][14][15][16][17][18][19][20]. From our experience with more than 1300 operations, we have summarized the indications for OUS.…”

“…Other surgeons have reported that OUS altered the surgical management of hepatic tumors in 30% to 50% of operations [ 14,15], similar to our results. Precise localization of nonpalpable hepatic tumors and islet cell tumors of the pancreas facilitates selection of appropriate operations [10][11][12][14][15][16][17][18]. OUS is more accurate for diagnosing liver metastasis than conventional preoperative studies and surgical exploration [4,19].…”

Intraoperative abdominal ultrasonography

“…Large series show that intraoperative insonation has impacted on surgical decision making in between 32 and 51 per cent of intended liver resections 6±11 . Its repeatability has also proved useful in guiding and directing the progress of resection 12 . Intraoperative ultrasonography has led to the development of new parenchyma-sparing hepatectomy procedures 13 , in particular systematic subsegmentectomy and hepatectomies which spare only the inferior right hepatic vein.…”

Intraoperative and laparoscopic sonography of the liver

“…In addition, the magnitude of operation (the so-called tissue-sparing hepatectomy) may be significantly reduced. That may have important implications, particularly in patients subjected to undergo extensive right trisegmentectomy that often leaves in place an insufficient liver volume to support life [38][39][40]. Similarly, intraoperative sonography has a major role in the performance of parenchyma-sparing hepatic resection in patients with hepatic tumours favoured by an underlying diffuse hepatic disease (such as cirrhosis) [32-34, 41, 42].…”