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The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma

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Abstract

In October, 1979, a new operative probe for liver surgery was developed. Since then, 386 patients who received laparotomy for hepatectomy underwent intraoperative ultrasonography. Of these, 245 patients had hepatocellular carcinoma (HCC), and 152 patients had tumors less than 5 cm in diameter. In these 152 patients, intraoperative sonography detected 198 of a total of 203 small HCC's (sensitivity: 99%), whereas the sensitivity of preoperative ultrasound, angiography, and computed tomography was 89.3%, 84.1%, and 89.6%, respectively. Intraoperative ultrasound had a much higher sensitivity in detecting daughter nodes as well as intraheptic metastasis, but slightly lower specificity in differentiating malignant nodules from benign lesions. Intraoperative sonography revealed 70% of tumor thrombi, while ultrasound and angiography disclosed only 21%. In patients with small HCC associated with liver cirrhosis, 65% had invisible and nonpalpable tumors.

Intraoperative ultrasonography led to the development of new liver-sparing hepatectomy procedures: systematic subsegmentectomy and hepatectomies which preserve the inferior right hepatic vein. Systematic subsegmentectomy was performed on 96 patients. Survival rates after this procedure in 58 patients with small HCC were 53.6±17.7% at 3 years and 47.9±19.1% at 5 years, which was much better than that of patients who received partial hepatectomy.

Intraoperative ultrasonography was indispensable in liver surgery, not only for diagnosis of the tumor spread in the liver, but also as a direct guide for hepatectomy.

Résumé

En Octobre, 1979, une nouvelle sonde opératoire pour pratiquer la chirurgie hépatique a été créee. Depuis, 386 malades ont été soumis à une laparotomie pour hépatectomie et à une échographie opératoire. Parmi eux, 245 malades étaient porteurs d'un cancer hépato-cellulaire et 152 présentaient des tumeurs d'un diamètre inférieur à 5 cm. Chez ces derniers l'échographie opératoire a révélé 198 petites tumeurs sur un total de 203 alors que le taux de la sensibilité est de 89.3% pour l'échographie pré-opératoire, 84.1% pour l'angiographie, et de 89.6% pour la tomodensitométrie. L'échographie eut une grande sensibilité en décelant les tumeurs filles et aussi les métastases hépatiques, une spécificité légèrement supérieure pour différencier les nodules malins des lésions malignes. L'échographie a révélé 70% des thrombi tumoraux alors que l'échographie et que l'angiographie en ont décelé seulement 21%. Chez les cirrhotiques qui étaient porteurs d'un cancer de petite taille 65% présentaient une tumeur invisible qui échappait à la palpation.

L'échographie opératoire a abouti à de nouvelles techniques d'hépatectomie limitée: sub-segmentectomie systématique et hépatectomie qui respecte la veine hépatique droite. Ce type d'hépatectomie a été pratiquée chez 96 opérés. Le taux de survie chez 58 d'entre eux qui étaient porteurs d'un cancer hépato-cellulaire de petite taille a été de 53.6±17.7% à 3 ans et de 47.9±19.1% à 5 ans, taux meilleur que celui obtenu par les sujets qui avaient subi une hépatectomie partielle.

L'échographie opératoire est indispensable pour pratiquer la chirurgie hépatique en permettant non seulement d'apprécier l'extension du processus tumoral mais aussi de guider l'hépatectomie.

Resumen

Una nueva sonda para cirugía hepática fue desarrollada en octubre de 1979. Desde entonces se ha realizado ultrasonografía operatoria en 386 pacientes sometidos a laparotomía para hepatectomía; 245 presentaban carcinoma hepatocelular (CHC) y 152 presentaban tumores de menos de 5 cm de diámetro. En estos 152 pacientes la sonografía intraoperatoria detectó a 198 de un total de 203 pequeños CHC's; lo cual significa una sensibilidad de 99%, cuando la sensibilidad de la ultrasonografía, angiografía, y tomografía computadorizada fue de 89.3, 84.1, y 89.6%, respectivamente. La ultrasonografía intraoperatoria demostró mucho mayor sensibilidad en la detección de nódulos satélites así como de metástasis hepáticas, pero ligeramente menor especificidad en la diferenciación entre nódulos malignos y lesiones benignas. La sonografía intraoperatoria reveló el 70% de los trombos tumorales, mientras la ultrasonografía y angiografía preoperatorias revelaron apenas el 21%. De los pacientes con pequeños CHC's asociados con cirrosis hepática, 65% tenían tumores invisible y no palpables.

La ultrasonografía intraoperatoria permitió la realización de nuevos procedimientos de hepatectomía conservadora de tejido, tales como la subsegmentectomía sistemática y la hepatectomía que préserva la vena hepática inferior derecha. La subsegmentectomía sistemática fue realizada en 96 pacientes. Las tasas de supervivencia después de subsegmentectomía sistemática en 58 pacientes con CHC's pequeños fue de 53.6±17.7% a 3 años y de 47.9±19.1% a 5 años, bastante mejores que las de los pacientes sometidos a hepatectomía parcial.

La ultrasonografía intraoperatoria demostró ser indispensable en cirugía hepática, no solo para el diagnóstico del grado de extensión del tumor dentro del hígado, sino también como guía directa para la hepatectomía.

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References

  1. Makuuchi, M., Hasegawa, H., Yamazaki, S.: Intraoperative ultrasonic examination for hepatectomy. Jpn. J. Clin. Oncol.11:367, 1981

    Google Scholar 

  2. Makuuchi, M., Hasegawa, H., Yamazaki, S.: Ultrasonically guided subsegmentectomy. Surg. Gynecol. Obstet.161:346, 1985

    Google Scholar 

  3. Makuuchi, M., Hasegawa, H., Yamazaki, S., Bandai, Y., Ito, T., Watanabe, G., Abe, H., Muroi, T., Giga, K., Kasai, C.: Newly devised intraoperative probe. Image Technology and Information Display-Medical11:1167, 1979

    Google Scholar 

  4. Makuuchi, M., Yamazaki, S., Hasegawa, H., Bandai, Y., Ito, T., Watanabe, G., Abe, H., Muroi, T., Giga, K., Kasai, C.: Ultrasonically guided liver surgery. Jpn. J. Ultrasonics Med.7:45, 1980

    Google Scholar 

  5. Makuuchi, M., Kamiya, K., Beppu, T., Futagawa, S., Sugiura, M., Wada, T., Abe, H., Muroi, T.: Ultrasonically guided percutaneous cholangical drainage and intraoperative electronic scanning for intrahepatic bile duct enteric anastomosis in patients with bile duct carcinoma at the porta hepatis. Proceedings of the 10th meeting of Jpn. Soc. Gastroenterol. Surg. 1977, p. 83

  6. Makuuchi, M.: Abdominal Intraoperative Ultrasonography, Tokyo, Igaku-Shoin (in press)

  7. Makuuchi, M., Hasegawa, H., Yamazaki, S., Takayasu, K.: Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg. Gynecol. Obstet.164:68, 1987

    Google Scholar 

  8. Couinaud, C.: Le Foie, Études Anatomiques et Chirurgicales, Paris, Masson et Cie, 1957

    Google Scholar 

  9. Makuuchi, M., Hasegawa, H., Yamazaki, S., Bandai, Y., Watanabe, G., Ito, T.: The inferior-right hepatic vein: Ultrasonic demonstration. Radiology148:213, 1983

    Google Scholar 

  10. Igawa, S., Kinoshita, H., Sakai, K.: Clinical significance of intraoperative sonography on hepatectomy in primary carcinoma of the liver. World J. Surg.8:772, 1984

    Google Scholar 

  11. Igawa, S., Sakai, K., Kinoshita, H., Hirohashi, K: Intraoperative sonography: Clinical usefulness in liver surgery. Radiology156:473, 1985

    Google Scholar 

  12. Nagasue, N., Suehiro, S., Yukaya, H.: Intraoperative ultrasonography in the surgical treatment of hepatic tumors. Acta Chir. Scand.150:311, 1984

    Google Scholar 

  13. Sheu, J.-C., Lee, C.-S., Sung, J.-L., Chen, D.-S., Yang, P.-M., Lin, T.-Y.: Intraoperative hepatic ultrasonography—an indispensable procedure in resection of small hepatocellular carcinomas. Surgery97:97, 1985

    Google Scholar 

  14. Plainfosse, M.C., Merran, S.: Intraoperative abdominal sonography. Radiology147:829, 1983

    Google Scholar 

  15. Bismuth, H., Castaing, D.: Echographie Per-opératoire due Foie et des Voies Biliaires, Paris, Flammarion Medecine-Sciences, 1985

    Google Scholar 

  16. Bismuth, D., Castaing, F., Kunstlinger, F.: L'échographie peropératoire en chirurgie hepato-biliaire. Presse Méd.13:1819, 1984

    Google Scholar 

  17. Belghiti, J., Menue, Y., Nakum, H., Fekete, F.: Apport de l'échotomographie per-opératoire dans la chirurgie des tumeurs du foie. Presse Med.13:1839, 1984

    Google Scholar 

  18. Castaing, D., Kunstlinger, F., Habib, N., Bismuth, H.: Intraoperative ultrasonographic study of the liver, method and anatomic results. Am. J. Surg.149:676, 1985

    Google Scholar 

  19. Gozzetti, G., Mazziotti, A., Bolondi, L., Cavallari, A., Grigioni, W., Casanova, P. Bellusci, R., Villanacci, V., Labò, G.: Intraoperative ultrasonography in surgery for liver tumors. Surgery99:523, 1986

    Google Scholar 

  20. Shanghai Coordinating Group for Research on Liver Cancer: Diagnosis and treatment of primary hepatocellular carcinoma in early stage, report of 134 cases. Chin. Med. J.92:801, 1979

    Google Scholar 

  21. Healey, J.E., Jr., Schroy, P.C.: Anatomy of the biliary ducts within the human liver. Am. J. Anat.90:59, 1952

    Google Scholar 

  22. Makuuchi, M., Hasegawa, H., Yamazaki, S., Moriyama, N., Takayasu, K., Hirohashi, S., Kishi, K.: Differences in clinicopathological features and clinical diagnosis of hepatocellular carcinoma among each diameter less than 5 cm and its treatment. Acta Hepatol. Jpn.24:1466, 1983

    Google Scholar 

  23. Shimamura, Y., Gunvén, P., Takenaka, Y., Shimizu, H., Akimoto, H., Shima, Y., Arima, K., Takahashi, A., Kitaya, T., Matsuyama, T., Hasegawa, H.: Selective portal branch occlusion by balloon catheter during liver resection. Surgery100:938, 1986

    Google Scholar 

  24. Makuuchi, M., Hasegawa, H., Yamazaki, S.: Ultrasonically guided subsegmentectomy. Surg. Gynecol. Obstet.161:346, 1985

    Google Scholar 

  25. Makuuchi, M.: A new hepatectomy procedure for preservation of the inferior right hepatic vein depending upon the variation of the hepatic veins. Surg. Gynecol. Obstet. (in press)

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Authors and Affiliations

  1. Departments of Hepatic Surgery and Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan

    Masatoshi Makuuchi M.D., Hiroshi Hasegawa M.D., Susumu Yamazaki M.D., Kenichi Takayasu M.D. & Noriyuki Moriyama M.D.

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  1. Masatoshi Makuuchi M.D.
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  2. Hiroshi Hasegawa M.D.
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  3. Susumu Yamazaki M.D.
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  4. Kenichi Takayasu M.D.
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  5. Noriyuki Moriyama M.D.
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Supported by the Princess Takamatsu Cancer Research fund and a Grant-in-Aid for Cancer Research of the Ministry of Health and Welfare in Japan.

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Makuuchi, M., Hasegawa, H., Yamazaki, S. et al. The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma. World J. Surg. 11, 615–621 (1987). https://doi.org/10.1007/BF01655837

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