Detection of new tumors by intraoperative ultrasonography during repeated hepatic resections for hepatocellular carcinoma.

OBJECTIVE To evaluate the efficacy of intraoperative (IO) ultrasonography (US) as compared with other imaging modalities on the primary and repeated hepatectomies for hepatocellular carcinoma. DESIGN Retrospective study. SETTING University hospital. PATIENTS From January 6, 1995, to December 26, 2002, 430 patients underwent 555 operations for hepatocellular carcinoma. MAIN OUTCOME MEASURES New tumors detected by IOUS at the primary and second hepatectomies were analyzed. The long-term outcomes were also studied. RESULTS Intraoperative US sensitivity was the highest. The detection rate by each imaging modality slightly but uniformly decreased at the second hepatectomy. Intraoperative US detected 56 new tumors in 30 cases (7.0%) at the primary hepatectomy and 13 new tumors in 8 cases (7.3%) at the second hepatectomy. The mean +/- SD tumor sizes were 8.7 +/- 3.8 mm and 9.0 +/- 5.2 mm at the primary and second resections, respectively. The preoperative surgical plan was changed owing to the IOUS findings alone in 24 cases (5.6%) at the primary hepatectomy and in 7 cases (6.4%) at the second. Although recurrence was frequent in patients with new tumors at the primary hepatectomy, long-term survival after appropriate treatment for recurrence was similar to that of patients without new tumors. CONCLUSIONS Despite the recent progress in imaging modalities, IOUS is still the most sensitive. The same degree of precaution is necessary for new tumors when performing IOUS during repeated hepatectomy. Patients with new tumors are at high risk for recurrence, so regular follow-up is important to prolong survival.