VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN THE SURGICAL-TREATMENT OF MALIGNANT LIVER-TUMORS

This retrospective study was designed to assess the specific contribution of intraoperative ultrasonography (IOU) in a series of 50 surgical procedures for malignant tumors of the liver (including 27 hepato-cellular carcinomas (HCC) secondary to cirrhosis and 18 metastases). Compared to conventional pre- and intra-operative investigations, IOU was more sensitive (81 %) but less specific (27 %) for detection of tumor nodules, but was inaccurate in detection of daughter nodules in hepato-cellular carcinomas (HCC) secondary to cirrhosis. The main specific contribution of IOU was assistance in performing surgery. In 14 cases (52 %) of HCC secondary to cirrhosis, IOU provided one or several additional pieces of information which resulted in changes of the planned surgical procedure in 11 cases (41 %) mainly enabling limited resection of small deep impalpable tumors. In 10 cases (37 %), IOU directly guided resection (echoguided segmentectomy or tumorectomy). Contribution of IOU was poor in primary carcinoma in noncirrhotic liver, but in 8 cases of metastasis (44 %) IOU provided additional information which resulted in changes of the intended surgical procedure in 5 cases (28 %) mainly leading to a more extensive resection. Finally IOU was considered to be indispensable in 15 cases of HCC cirrhosis (56 %) and in 5 cases of metastasis (28 %).