title: Intraoperative sonography during open partial nephrectomy for renal cell cancer: does it alter surgical management?
abstract: OBJECTIVE
  The purpose of this study is to evaluate whether intraoperative ultrasound (IOUS) during open partial nephrectomy alters the surgical management for renal cell cancer (RCC).
  
  
  METHODS
  One hundred ninety-eight consecutive patients undergoing IOUS during open partial nephrectomy for RCC were selected for retrospective review of clinical and imaging data. Patient age and sex, the local extent of the primary lesion, and the presence of additional lesions were recorded. Ultrasound findings were compared with preoperative CT or MRI to determine whether the IOUS findings changed surgical management. Summary statistics were performed to assess what percentage of patients with additional IOUS findings had a change in their surgical management. The Kaplan-Meier method was used to estimate 5-year overall survival (OS) and event-free survival (EFS) rates for all patients. Patients were followed for 9-12 years to assess survival and measure recurrence rates.
  
  
  RESULTS
  Twenty-one of 198 patients (10.6%; 95% CI, 6.7-15.8%) had additional findings on IOUS not seen on preoperative imaging. As a result, surgery was modified in 15 of these 21 patients (71.4%; 95% CI, 47.8-88.7%). The 5-year OS rate was 81%, and the EFS rate was 76% for the whole group; most deaths were due to unrelated causes. There was no statistically significant difference in OS (p = 0.867) and EFS (p = 0.069) rates among patients who had a change of management because of additional lesions seen by IOUS.
  
  
  CONCLUSIONS
  IOUS performed during open partial nephrectomy for resection of RCC shows additional findings compared with preoperative cross-sectional imaging that may alter surgical management.
authors.affiliation: 1 Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Unit 1350, 1515 Holcombe Blvd, Houston, TX 77030.
authors.forename: Priya R
authors.initials: PR
authors.lastname: Bhosale
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.forename: Randy D
authors.initials: RD
authors.lastname: Ernst
authors.forename: Tharakeswara K
authors.initials: TK
authors.lastname: Bathala
authors.forename: Rhoda M
authors.initials: RM
authors.lastname: Reading
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Deepak G
authors.initials: DG
authors.lastname: Bedi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000401:mortality*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000401:mortality*; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014463:Ultrasonography / Q000706:statistics & numerical data*
keywords: imaging findings; intraoperative ultrasound; renal mass; surgical management