Use of intraoperative ultrasound during hepatic resection in pediatric patients

Intraoperative ultrasound for liver tumor resection in children

“…The current literature supporting the use of IOUS in children is limited to one study of five children [15]. The present study highlights a larger series of children from a single institution where IOUS was performed for every case and supports the critical importance of IOUS in the pediatric population.…”

Early deaths in childhood cancer

“…It is now realized that preoperative chemotherapy can make total resection of hepatoblastomas more feasible and reduce perioperative morbidity and mortality [26,27]. Specific surgical developments, including the use of intraoperative ultrasound to assist in determining vascular relationships and extent of tumor [28], preoperative embolization in selected cases [29], and use of hypothermia with circulation arrest to remove vascular extensions [30], might also have contributed to the decreasing early mortality in these patients.…”

Liver tumors: Pediatric population

“…For example, in the SIOPEL‐1 study, preoperative PRETEXT staging compared with pathology was correct in 51%, overstaged in 37%, and understaged in 12% of patients 42. In certain cases, especially multifocal HB, intraoperative ultrasound can improve the depiction of tumor extent and assist with the planning of the most appropriate surgical strategy 51, 52. Liver transplantation is a viable option for children with lung metastases that clear with preoperative chemotherapy or surgical resection by the time of transplantation 53, 54…”

“…At exploration, complete mobilization of the liver is first performed to carefully examine for extrahepatic spread and multifocal disease. Intraoperative ultrasound can help delineate the extent of disease and assess tumor proximity to major hepatic vessels 51, 52. Although a parenchymal margin greater than 1 cm is recommended, it is often difficult, if not impossible, to achieve this large a portal venous or hepatic venous margin.…”