Ultrasound-guided liver resection: Early experience in a district general hospital

Abstract

KEYWORDSIntraoperative ultrasonography; Liver resection; Hepatocellular carcinoma; Liver metastases.Abstract Introduction: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumorevessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. Methods: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. Results: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1e4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1e12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. Conclusions: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.Sommario Premessa: Nell'ambito della chirurgia epatica l'ecografia intraoperatoria svolge un ruolo ben codificato nella stadiazione e nella pianificazione della strategia operatoria. L'importanza dell'ampio utilizzo di questa metodica anche durante la resezione è stata riportata solo da alcuni autori. Questo studio ha come scopo di verificare quali siano i risultati a breve termine di un ampio utilizzo dell'ecografia durante la resezione stessa in un ospedale periferico. Metodi: Nell'arco di 24 mesi 11 pazienti consecutivi sono stati sottoposti a resezione epatica ecoguidata. I dati perioperatori sono stati raccolti in modo prospettico per valutare l'influenza di questa metodica sulla mortalità, morbidità e recidive locali. * Corresponding author. via Peschiera 40/7, 16122 Genova, Italia.E-mail address: pietrogrondona@yahoo.com (P. Grondona). Risultati: Otto pazienti erano maschi. Età mediana 74 anni. Quattro HCC, 4 metastasi, 1 colangiocarcinoma periferico, 1 emangioma, 1 pseudotumore infiammatorio. Sono state eseguite 3 resezioni a cuneo, 3 subsegmentectomie, 4 segmentectomie e 3 bisegmentectomie. La perdita ematica mediana è stata 235 ml. In caso di tumore il margine di exeresi mediano è st...

Comparison of Intraoperative Sonography and Histopathologic Evaluation of Tumor Thickness and Depth of Invasion in Oral Tongue Cancer: A Pilot Study

“…Intraoperative US has been shown to be critically helpful in the guidance of tumor resection in various parts of the body. 8 Realtime sonography performed immediately before and during surgical resection can help to inform the resection trajectory by demonstrating the tumor and illustrating exophytic or endophytic components, as well as the surrounding uninvolved tissue, clearance margin between tumor and resection surface, vessels, and so forth. With real-time sonography, the surgeon can be reassured that the resection trajectory (for the purpose of tumor clearance) is adequate and optimal, or can be alerted to the need to modify the resection trajectory (for the purpose of organ preservation) to balance the need for adequate tumor margins and preservation of the maximal amount of uninvolved tissue.…”

Use of Intraoperative Ultrasound (IOUS) in Liver Surgery

“…IOUS is more superior in detecting liver lesion than preoperative MRI and CT scan with sensitivity of 95-100% in comparison to others, 80% for CT, and 70% for percutaneous ultrasound. It is very helpful in liver resection for liver malignant tumors and will improve patient survival by taking safety liver resection; with the use of IOUS, limited liver tumor resection can be done in a non-segmental way and will improve patient survival especially in a patient with hepatocellular carcinoma with a background of cirrhosis [25][26][27][29][30][31][32][33]. IOUS may have difficulty in detecting small liver lesion in a fatty liver; however, the use of contrast-enhanced ultrasound will be more beneficial [22][23][24]28].…”