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Published in:

01-12-2011

Value of Visual Inspection, Bimanual Palpation, and Intraoperative Ultrasonography During Hepatic Resection for Liver Metastases of Colorectal Carcinoma

Authors: Shojiro Hata, Hiroshi Imamura, Taku Aoki, Takuya Hashimoto, Masaaki Akahane, Kiyoshi Hasegawa, Yoshifumi Bekku, Yasuhiko Sugawara, Masatoshi Makuuchi, Norihiro Kokudo

Published in: World Journal of Surgery | Issue 12/2011

Abstract

Background

Intraoperative detection of new nodules is common in patients undergoing hepatectomy for colorectal liver metastases, although the value of intraoperative diagnosis is not well assessed.

Methods

A prospectively collected and recorded database was retrospectively analyzed. Helical computed tomography (CT) results were correlated with those of the intraoperative diagnosis in 183 consecutive patients undergoing 254 consecutive hepatectomies, including repeated resection for colorectal liver metastases.

Results

In total, 270 nodules were newly detected during 65 hepatectomies. The sensitivity of CT to detect metastatic nodules was 72.8% (722/992), but it decreased to 34.6% (125/361) for small (≤1 cm diameter) tumors. Intraoperative visual inspection and/or palpation detected 207 of 270 nodules. Intraoperative ultrasonography (IOUS) played an important role in identifying deep (≥1 cm from the surface) and comparatively small (≤1 cm diameter) nodules (4/9 vs. 16/18, respectively, for those >1 cm vs. ≤1 cm diameter). The likelihood of intraoperative detection of new nodules increased from 10 in 112 to 6 in 9 when the preoperative tumor number increased from solitary to ≥10, resulting in an overall likelihood of 65 in 254 (25.6%). Of 65 patients with new nodules, 21 had at least one nodule that was detected only by IOUS. Preoperatively scheduled hepatectomy was altered in 47 (72%) patients, although additional limited resection(s) were sufficient to remove these nodules in 43 (91%) of them.

Conclusions

Visual inspection, palpation, and IOUS had equally indispensable roles in detecting new nodules during hepatectomy. Detection was common and usually necessitated alteration, albeit moderately, of the surgical plan.

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Title: Value of Visual Inspection, Bimanual Palpation, and Intraoperative Ultrasonography During Hepatic Resection for Liver Metastases of Colorectal Carcinoma
Authors: Shojiro Hata
Hiroshi Imamura
Taku Aoki
Takuya Hashimoto
Masaaki Akahane
Kiyoshi Hasegawa
Yoshifumi Bekku
Yasuhiko Sugawara
Masatoshi Makuuchi
Norihiro Kokudo
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-011-1264-7

At a glance: The STEP trials

Springer Medicine

Value of Visual Inspection, Bimanual Palpation, and Intraoperative Ultrasonography During Hepatic Resection for Liver Metastases of Colorectal Carcinoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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