Effect of Intraoperative Ultrasonography on Change of Surgical Decision for Patients with Hepatocellular Carcinoma

Abstract

Background: Hepato cellular carcinoma (HCC) is one of the most common cancers worldwide. Intra operative ultrasonography (IOUS) is considered an indispensable operative procedure for intra operative decision-making and guidance of surgical procedures. IOUS had changed hepatic surgery dramatically because it was the only modality that was capable of delineating and examining the interior of the liver during surgery especially after incorporation of color Doppler imaging and laparoscopic ultrasound into IOUS in1990s. IOUS can accurately define the hepatic segmental boundaries as well as the tumor boundaries. The use of IOUS started in Japan and from there it spread worldwide allowing for the development of different therapies to treat patients with HCC. Our aim was to determine if IOUS can changes surgical decision in hepatic resection for HCC. Methods: We retrospectively analyzed 48 consecutive liver resections performed at multiple centers over 3 years. Preoperative surgical decision was based on ultrasonography, computed tomography and/or dynamic magnetic resonance imaging (DMRI). The size, location and number of lesions were determined by IOUS and compared with 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: This study was conducted on 48 HCC consecutive patients 27 males and 21 females with age range from 49 to 67 years. Hepatic resection was decided as the treatment of choice for all patients. During operation direct inspection and palpation of the liver followed by IOUS were done. The operative decision was changed in 17 patients (35.4%), this was due to finding new additional tumors in 13 cases, and 4 cases showed change in tumour size on background of cirrhosis. Conclusion: We found that IOUS findings directly changed the operative surgical decision in 35.4 % of cases. Surgery was more accurately performed with IOUS. Despite the improvement of preoperative imaging modalities, IOUS can correctly define the hepatic segments as well as the extent of a tumor so it help for best operative decision in hepatic resections.