title: Appraisal of a manual blunt dissection for an intraoperative diagnosis of extrahepatic cancer invasion.
abstract: OBJECTIVE
  Liver cancer extension to the adjacent organs does not necessarily indicate tumor invasion. It is very hard to diagnose extrahepatic cancer invasion to the adjacent organs using preoperative imaging. This study was undertaken, therefore, to determine the real cancer invasion using a manual dissection.
  
  
  METHODS
  Of the 51 consecutive patients with liver cancer, 6 cases with extrahepatically growing tumors were suspected to have cancer invasion both preoperatively and intraoperatively. Thus, we diagnosed whether or not any real extrahepatic cancer invasion was present by either removing the tumour by hand or by performing a blunt gauze dissection.
  
  
  RESULTS
  Three hepatocellular carcinomas and one metastatic cancer were stripped off from the adjacent organ using a manual blunt dissection. However, the other two tumors could not be removed in the same manner and therefore a combined resection of the invaded portion had to be performed along with the hepatectomy. A postoperative detailed pathological examination revealed no cancer cells on the surface of the adjacent organ in the former 4 tumors. Cancer invasion was recognized, however, on the outside of the liver in the latter 2 combined resected tumors.
  
  
  CONCLUSIONS
  An accurate intraoperative diagnosis of extrahepatic cancer invasion can be made using manual blunt dissection.
authors.affiliation: Department of Surgery, Iizuka Hospital, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ezaki
authors.forename: N
authors.initials: N
authors.lastname: Koyanagi
authors.forename: T
authors.initials: T
authors.lastname: Toyomasu
authors.forename: Y
authors.initials: Y
authors.lastname: Ikeda
authors.forename: N
authors.initials: N
authors.lastname: Nakanishi
authors.forename: K
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D003964:Diaphragm / Q000473:pathology; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007668:Kidney / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness