Operative ultrasound establishes resectability of metastases by major hepatic resection

Abstract

In this study, the utility of intraoperative ultrasound in the surgical management of hepatic colorectal metastases requiring hepatic resection has been demonstrated. The intraoperative ultrasound technique has been described as a method to accurately monitor curative resection of large colorectal metastases requiring anatomical procedures such as right hepatic trisegmentectomy, bisegmentectomy, and hepatic lobectomy. Preoperative analysis of the patients reported utilizing either computed tomography, ultrasound, or magnetic resonance imaging demonstrated very well the extent of tumor but could not define a major anatomical resection along normal tissue planes. In the 3 patients demonstrated, intraoperative ultrasound was able to confirm a normal hepatic parenchymal dissection overlying the extensive tumors and enabled completion of the curative resections. Furthermore, we have described the intraoperative ultrasound criteria for assessment of resectability. These included a definition of the proximity of the major portal and hepatic venous structures, exclusion of simultaneous minimal metastatic disease in the remaining parenchyma, and the distinction between marginal resectability and resectability for cure along the proposed parenchymal dissection plane. We conclude that intraoperative ultrasound is important in the surgical management of metastatic colorectal cancer and can provide for a more complete clinical staging and appropriate selection of patients for curative major hepatic resection.