The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma

Abstract In October, 1979, a new operative probe for liver surgery was developed. Since then, 386 patients who received laparotomy for hepatectomy underwent intraoperative ultrasonography. Of these, 245 patients had hepatocellular carcinoma (HCC), and 152 patients had tumors less than 5 cm in diameter. In these 152 patients, intraoperative sonography detected 198 of a total of 203 small HCC's (sensitivity: 99%), whereas the sensitivity of preoperative ultrasound, angiography, and computed tomography was 89.3%, 84.1%, and 89.6%, respectively. Intraoperative ultrasound had a much higher sensitivity in detecting daughter nodes as well as intraheptic metastasis, but slightly lower specificity in differentiating malignant nodules from benign lesions. Intraoperative sonography revealed 70% of tumor thrombi, while ultrasound and angiography disclosed only 21%. In patients with small HCC associated with liver cirrhosis, 65% had invisible and nonpalpable tumors . Intraoperative ultrasonography led to the development of new liver‐sparing hepatectomy procedures: systematic subsegmentectomy and hepatectomies which preserve the inferior right hepatic vein. Systematic subsegmentectomy was performed on 96 patients. Survival rates after this procedure in 58 patients with small HCC were 53.6±17.7% at 3 years and 47.9±19.1% at 5 years, which was much better than that of patients who received partial hepatectomy . Intraoperative ultrasonography was indispensable in liver surgery, not only for diagnosis of the tumor spread in the liver, but also as a direct guide for hepatectomy .