title: Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence.
abstract: BACKGROUND
  Intraoperative ultrasonography (IOUS) may allow a more conservative procedure in patients with liver tumours involving a hepatic vein at the caval confluence. The aim of this study was to determine whether IOUS and colour Doppler IOUS might reduce the rate of major hepatectomy and vascular reconstruction in patients with such tumours.
  
  
  METHODS
  Of 133 consecutive patients with a liver tumour who underwent hepatectomy, 22 had involvement of a hepatic vein at the caval confluence. The surgical strategy employed was determined by IOUS findings of the relationship between the tumour and hepatic vein, the presence of accessory veins, and portal flow as measured by colour Doppler IOUS following clamping of the hepatic vein to be resected. Mortality, morbidity, major resection, hepatic vein reconstruction and local recurrence rates were evaluated.
  
  
  RESULTS
  There were no hospital deaths and only one patient suffered major morbidity. Although hepatic vein resection was performed in 15 patients, only two underwent major hepatectomy and none had vascular reconstruction. No patients had tumour recurrence at a mean follow-up of 23 months.
  
  
  CONCLUSIONS
  IOUS allowed sparing of the liver parenchyma without tumour recurrence in most patients with a tumour involving a hepatic vein at the caval confluence, avoiding more extensive hepatectomy or vascular reconstruction.
authors.affiliation: Third Department of Surgery, University of Milan, Faculty of Medicine, Istituto Clinico Humanitas-Istituto di Ricerca e Cura a Carattere Scientifico, Rozzano, Milan, Italy. guido.torzilli@unimi.it <guido.torzilli@unimi.it>
authors.forename: G
authors.initials: G
authors.lastname: Torzilli
authors.forename: M
authors.initials: M
authors.lastname: Montorsi
authors.forename: D
authors.initials: D
authors.lastname: Del Fabbro
authors.forename: A
authors.initials: A
authors.lastname: Palmisano
authors.forename: M
authors.initials: M
authors.lastname: Donadon
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D015331:Cohort Studies; D015179:Colorectal Neoplasms; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional