Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Impact of intraoperative ultrasound staging on surgical strategy and recurrence after resection for intrahepatic cholangiocarcinoma.
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Langella Serena, Maurino Ludovica, Ferrari Chiara, Russolillo Nadia, Fontana Andrea Pierluigi, Lo Tesoriere Roberto, Ferrero Alessandro
Аннотация
BACKGROUND: Intraoperative ultrasound (IOUS) is central to liver surgery, but its incremental staging value in intrahepatic cholangiocarcinoma (ICC) remains poorly defined.
METHODS: We retrospectively analyzed a prospectively maintained database of patients considered for curative-intent liver resection for suspected ICC from January 2004 to December 2024. The primary endpoint was the incremental intraoperative staging yield of IOUS/laparoscopic ultrasound (LUS), defined as the proportion of resected patients with at least 1 additional pathologically confirmed ICC nodule. Secondary endpoints were changes in surgical strategy, factors associated with incremental detection, and oncological outcomes.
RESULTS: Of the 208 patients considered for resection, 17 had unresectable disease on 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 2 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. The time to first recurrence was shorter in patients with additional ICC nodules (6.6 vs 16.7 months, P <.001).
CONCLUSION: IOUS/LUS provides clinically relevant incremental staging, refines surgical strategy, and identifies patients at increased risk of early recurrence. These findings support its routine use during curative-intent surgery for ICC.
METHODS: We retrospectively analyzed a prospectively maintained database of patients considered for curative-intent liver resection for suspected ICC from January 2004 to December 2024. The primary endpoint was the incremental intraoperative staging yield of IOUS/laparoscopic ultrasound (LUS), defined as the proportion of resected patients with at least 1 additional pathologically confirmed ICC nodule. Secondary endpoints were changes in surgical strategy, factors associated with incremental detection, and oncological outcomes.
RESULTS: Of the 208 patients considered for resection, 17 had unresectable disease on 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 2 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. The time to first recurrence was shorter in patients with additional ICC nodules (6.6 vs 16.7 months, P <.001).
CONCLUSION: IOUS/LUS provides clinically relevant incremental staging, refines surgical strategy, and identifies patients at increased risk of early recurrence. These findings support its routine use during curative-intent surgery for ICC.