Impact of intraoperative ultrasound staging on surgical strategy and recurrence after resection for intrahepatic cholangiocarcinoma.

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.