Surgical Planning of Hepatic Metastasectomy Using Radiologist-Performed Intraoperative Ultrasound

Author Info

Alexandre Menard Diederick Jalink Lauren O’Malley Shannon Wong Sulaiman Nanji

Corresponding Author

Sulaiman Nanji
Department of Surgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada

A B S T R A C T

Background: Intraoperative ultrasound (IOUS) of the liver is a useful adjunct for surgical planning during hepatic metastasectomy. This study aims to (1) report the frequency of change in operative plan as a result of IOUS findings and (2) determine whether IOUS is still beneficial after implementing a standardized, comprehensive process of preoperative hepatic imaging. Methods: First, a retrospective review of all patients undergoing hepatic metastasectomy at a single institution was conducted to identify how frequently IOUS findings altered the surgical plan. Second, a prospective study was conducted where patients underwent both preoperative CT and MRI within 30 days before surgery to determine if IOUS may still have benefit despite the implementation of a standardized preoperative imaging protocol. Results: In the retrospective review, 39 liver resections were completed; 100% and 36% of patients underwent preoperative CT and MRI, respectively. The mean time between preoperative imaging and surgery was 46 days (7-126). Operative plans were changed in 10/39 (26%) cases based on IOUS. After the standardization of preoperative imaging, 27 liver resections were performed. All patients underwent preoperative CT and MRI; the mean time between preoperative imaging and surgery was 20 days (1-98) (p=0.001). The operative plan was amended in 5/27 (19%) cases based on IOUS (χ 2=1.405, p=0.24). Conclusion: Even after standardizing the quality and timing of preoperative imaging, the operative plan was changed in nearly 1/5 patients due to IOUS. These findings demonstrate the utility of IOUS in surgical planning for hepatic metastasectomy and provide the basis for a quality improvement strategy regarding standardized preoperative imaging.

Article Info

Article Type

Research Article

Publication history

Received: Mon 20, Apr 2020
Accepted: Mon 04, May 2020
Published: Tue 12, May 2020

Copyright

© 2023 Sulaiman Nanji. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JSO.2020.03.02