The value of intraoperative ultrasound in the management of primary and metastatic liver malignancies

The purpose of our study was to analyze the value of intraoperative ultrasound (IOUS) in the management of liver tumors. Abdominal ultrasonography has also some technical limits, for example reflections from bones or meteoristic bowels. Nine years ago at the Conference of Gastroenterology in Balatonaliga we reported the results of a retrospective study of 452 IOUS examinations which were performed in the previous ten-year period.

Material Since 1996 we have carried out 118 further intraoperative examinations at our clinic until now. Forty-seven of our patients suffered from liver metastases of colorectal cancer. In 71 further cases we used this method for the staging of liver tumors or liver metastases of non-colorectal origin. We made these examinations prospectively in those patients who suffered from primary hepatic neoplasms or colorectal cancers with or without liver metastases.

Results All the preoperatively known tumors were detected by the IOUS. In further 37 cases previously unknown nodules were found. According to our experience this method should be used for the detection of preoperatively unknown and/or intraoperatively non-palpable metastases. This method should also be used at non-anatomical liver resections in order to visualize the exact position of vessels and bile ducts.

Discussion Based on our experience the IOUS examination helps us find preoperatively unknown liver metastases, answer the question of operability, and also shorten the operation time. More benefit can be gained by combining the IOUS with intraoperative FNAB to have reliable information concerning the dignity of the pathology. In our opinion the IOUS examination is a feasible method in liver operations and it should be used more frequently.