title: Stereotactic excision of additional lesions detected with intraoperative ultrasound examination during radiofrequency dissecting sealar (habib®) assisted hepatic metastasectomy: report of 4 cases.
abstract: Intraoperative ultrasound has been using to achieve a proper resection strategy in patients undergoing a hepatic colorectal metastasectomy. This study aims to describe and reveal the place of stereotactic metastasectomy in nonpalpable colorectal liver metastases (CLM). A chart review was initiated for all patients underwent resection for CLM between 2006 and 2011. The data concerning perioperative data and intraoperative strategy were abstracted. Among the 58 patients, who underwent a resection for CLM, 4 (6.9 %) (all men, median age 65.5, range 49-72, years) necessitated a stereotactic metastasectomy. Preoperative evaluations showed 1 (n = 1), 2 (n = 2), or 3 (n = 1) lesions, and intraoperative ultrasound (IUS) found an additional lesion in a case. Stereotactic marking was performed for nonpalpable lesions located in segments IVA, II, and VI and at the junction of segments V and VI. The margins were negative for all lesions both resected with conventional and stereotactic techniques. The examinations of the stereotactic resection materials revealed metastatic adenocarcinoma (patients n = 2), focal nodular hyperplasia (n = 1), and abnormal benign liver histology probably induced by chemotherapy (n = 1). The median (range) operation and hospitalization periods were 217.5 (150-310) minutes and 5.5 (2-9) days. No complications were observed except biliary fistula in a case, which spontaneously disappeared within 2 weeks. A patient died due to systemic disease including hepatic metastases 33 months after the liver surgery. Stereotactic metastasectomy may be feasible for the removal of nonpalpable CLM. Further evaluations are necessitated to understand the accurate place of this novel technique.
authors.affiliation: General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey ; Altayçeşme Mah. Varna Sok. No:15/B D:2 Menekşe Sit., Maltepe, Istanbul, 34843 Turkey.
authors.forename: Yunus E
authors.initials: YE
authors.lastname: Altuntas
authors.affiliation: Radiology Department of Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Sacide
authors.initials: S
authors.lastname: Unel
authors.affiliation: General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Fazlı C
authors.initials: FC
authors.lastname: Gezen
authors.affiliation: General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Nihat
authors.initials: N
authors.lastname: Aksakal
authors.affiliation: General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Civil
authors.affiliation: General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Selahattin
authors.initials: S
authors.lastname: Vural
authors.affiliation: Radiology Department of Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozates
authors.affiliation: General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey ; Medical College of Gumushane University, Gumushane, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Oncel
keywords: Hepatic metastasectomy; Radiofrequency dissecting sealar; Stereotactic excision