title: Ultrasound guided liver resection: does this approach limit the need for portal vein embolization?
abstract: OBJECTIVE
  Major hepatectomy is associated with higher risks of morbidity and mortality. Portal vein embolization (PVE) has been advocated to minimize those risks. However, PVE itself has associated drawbacks. The use of ultrasound-guided liver resection minimizes the need for major resection, and might reduce the use of PVE. The aim of this study was to validate this hypothesis.
  
  
  METHODS
  Two hundred and ninety-eight consecutive patients who underwent liver surgery were reviewed. Eighty-five of these patients with tumors corresponding to right 1st/2nd order portal branches (Zone P) and right hepatic vein (Zone H) were selected as potential candidates for major hepatectomy and PVE. Indications to PVE were based on the most recent reported criteria. Surgical strategy was based on the relationship between the tumor and the intrahepatic vascular structures at intraoperative ultrasonography (IOUS).
  
  
  RESULTS
  Thirty-six (42%) patients with tumors located in Zones H and P were potential candidates to PVE, but none underwent this procedure. Major hepatecomies were performed in 10 (12%) patients. No hospital mortality was seen. Morbidity rate was 19% and major morbidity occurred in 2 patients. Blood transfusion rate was 12%. Mean tumor-free margin was 0.1 cm (median 0.1; range 0-0.6). None had local recurrence after a mean follow-up of 28 months (median 27; range 6-68).
  
  
  CONCLUSIONS
  IOUS guidance allows an alternative, safe, and effective surgical approach for patients generally submitted to major hepatectomy and most of them to preoperative PVE. In this perspective, further studies are required to reassess indications to PVE.
authors: Third Department of Surgery, University of Milan School of Medicine, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. guido.torzilli@unimi.it
authors: Guido
authors: G
authors: Torzilli
authors: Matteo
authors: M
authors: Donadon
authors: Angela
authors: A
authors: Palmisano
authors: Matteo
authors: M
authors: Marconi
authors: Fabio
authors: F
authors: Procopio
authors: Florin
authors: F
authors: Botea
authors: Daniele
authors: D
authors: Del Fabbro
authors: Alessandro
authors: A
authors: Cappellani
authors: Marco
authors: M
authors: Montorsi
mesh_terms: D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D011169:Portal Vein; D014463:Ultrasonography