Impact of Intraoperative Ultrasound Staging on Surgical Strategy and Recurrence After Resection for Intrahepatic
S Langella1, L Maurino1, C Ferrari1
1Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy.
Background:
Intraoperative ultrasound is central to liver surgery, but its incremental staging value in intrahepatic cholangiocarcinoma remains poorly defined.
Methods:
We retrospectively analyzed a prospectively maintained database of patients considered for curative-intent liver resection for suspected intrahepatic cholangiocarcinoma from January 2004 to December 2024. The primary endpoint was the incremental intraoperative staging yield of IOUS/LUS, defined as the proportion of resected patients with at least one additional pathologically confirmed ICC nodule. Secondary endpoints were changes in surgical strategy, factors associated with incremental detection, and oncologic outcomes.
Results:
Of 208 patients considered for resection, 17 were found to have unresectable disease at staging laparoscopy/LUS and 191 underwent hepatectomy. IOUS/LUS prompted resection of 35 additional suspicious nodules; 33 were confirmed as ICC in 21 patients (11.0%), whereas two were benign. The surgical plan changed in 34 patients (17.8%): in 21 because of additional nodules and in 13 because of previously unrecognized vascular relationships. Time to first recurrence was shorter in patients with additional ICC nodules (6.6 vs 16.7 months, p<0.001).
Conclusion:
IOUS/LUS provided clinically relevant incremental staging, refined surgical strategy, and identified patients at increased risk of early recurrence. These findings support its routine use during curative-intent surgery for intrahepatic cholangiocarcinoma.