Detection of New Tumors by Intraoperative Ultrasonography During Repeated Hepatic Resections for Hepatocellular Carcinoma

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Abstract
Since its development in the late 1970s, intraoperative (IO) ultrasonography (US) has been widely used in liver surgery. It is now an indispensable tool for final diagnostic imaging before the resection of primary and secondary liver tumors.1-4 During liver resection for hepatocellular carcinoma (HCC), IOUS detects new lesions in 13.1% to 30% of cases5-8 and the operative plan has to be changed according to the IOUS findings. It is well known that the rate of recurrence of HCCs is very high, and approximately 70% of patients develop cancer recurrence within 5 years after curative liver resection.9-12 For recurrent HCCs, repeated liver resection provides the best chance for a cure. This approach has recently been adopted routinely in cancer center hospitals.13 Intraoperative US is also actively used in repeated resections; however, to our knowledge, there have been no reports of the significance of IOUS in the setting of repeated liver resection.