Intraoperative ultrasonography of liver: detection of occult liver tumors and treatment by cryosurgery.
A prospective study of 110 patients undergoing liver surgery was undertaken to evaluate the usefulness of intraoperative ultrasonography (IOUS) and cryosurgery in treating primary and metastatic liver tumors. The diagnoses were colorectal cancer (n = 72), hepatocellular carcinoma (n = 15), ovarian cancer (n = 8), cholangiocarcinoma (n = 4), and other tumors (n = 11). IOUS results were compared with preoperative CT scan angioportography. IOUS detected 37 lesions not seen on CT in 21 patients (19%) and 13 lesions not detected by bimanual palpation in 6 patients (5%). IOUS-assisted cryosurgery was carried out to ablate unresectable liver tumors in 21 patients (19%). At median follow-up of 14 months, 5/21 patients (24%) achieved complete response; 24 and 52% of patients recurred in the liver and systematically, respectively. Thus, IOUS is useful in detecting occult liver tumors and in providing assistance in tumor ablative therapies. Cryosurgery is useful in controlling some of the unresectable liver tumors, but the 76% recurrence rate implies the need for an effective regional and systemic chemo/immunotherapy.
Division of Surgical Oncology, Yale University School of Medicine.
T S
TS
Ravikumar
S
S
Buenaventura
R R
RR
Salem
B
B
D'Andrea
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000473:pathology; D010173:Palpation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography