Surgical treatment of hepatic metastases: impact of intraoperative sonography.

OBJECTIVE

A prospective study was done to determine the influence of intraoperative sonographic findings on surgical decision making in patients with hepatic metastases.

SUBJECTS AND METHODS

Thirty-seven consecutive patients with hepatic metastases who underwent surgery (for hepatic resection or intraarterial catheter placement) were prospectively evaluated. For each patient, the resectability of the metastases and the surgical approach were determined preoperatively on the basis of the combined results of sonography, bolus dynamic CT, and CT during arterial portography (CTAP). Those determinations were compared with the decisions made during surgery, which were based on the intraoperative sonographic findings. The surgical procedure that was actually performed was compared with the procedure decided on preoperatively.

RESULTS

Eighty-two metastases were surgically and pathologically proved. Preoperatively, 73 (89%) of the 82 metastases were detected with a combination of sonography, bolus dynamic CT, and CTAP. Seventy-nine metastases (96%) were detected with intraoperative sonography. Six metastases in four patients were detected only with intraoperative sonography. Furthermore, in two patients, intraoperative sonography showed four additional metastases, which changed the initial surgical approach decided on preoperatively.

CONCLUSION

Our study suggests that intraoperative sonography provides important data that cannot be obtained with preoperative imaging techniques and affect the surgical decision making in patients with hepatic metastases.