Alexandre  Menard,Diederick  Jalink,Lauren  O’Malley,Shannon Wong,Sulaiman  Nanji,
Surgical Planning of Hepatic Metastasectomy Using Radiologist-Performed Intraoperative Ultrasound
Journal of Surgical Oncology
2020
2674-3000
http://dx.doi.org/10.31487/j.JSO.2020.03.02
https://www.sciencerepository.org/surgical-planning-of-hepatic-metastasectomy-using-radiologist-performed-intraoperative-ultrasound_JSO-2020-3-102 
Abstract: 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.Keywords: Liver resection, metastases, ultrasound, imaging, standardization, operative plan