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Echogenic Appearance of Colorectal Liver Metastases on Intraoperative Ultrasonography is Associated with Survival After Hepatic Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Survival after resection of colorectal liver metastases has traditionally been associated with clinicopathologic factors. We sought to investigate whether echogenicity of colorectal liver metastasis as assessed by intraoperative ultrasound (IOUS) was a prognostic factor after hepatic resection. Prospective data on tumor IOUS appearance were collected in 84 patients who underwent hepatic resection for colorectal liver metastasis. Images were digitally recorded, blindly reviewed, and scored for echogenicity (hypo-, iso-, or hyperechoic). The median tumor number was 1 and the median tumor size was 5.0 cm. At the time of surgery, the IOUS appearance of the colorectal liver metastases were hypoechoic in 35 (41.7%) patients, isoechoic in 37 (44.0%) patients, and hyperechoic in 12 (14.3%) patients. Traditional clinicopathologic prognostic factors were similarly distributed among the three echogenicity groups (all p > 0.05). Patients with a hypoechoic lesion had a significantly shorter median survival (30.2 months) compared with patients who had either an isoechoic (53.2 months) or hyperechoic (42.3 months) lesion (p = 0.005). The 5-year survival after hepatic resection of colorectal liver metastasis was also associated with the echogenic appearance of the lesion (hypoechoic 14.4 vs isoechoic 37.4 vs hyperechoic 46.2%) (p < 0.05). Intraoperative ultrasound echogenicity should be considered a prognostic factor after hepatic resection of metastatic colorectal cancer.

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Acknowledgement

Dr. Michelle L. DeOliveira (BEX 153204) and Dr. Ana L. Gleisner (BEX 1128/05-1) are supported by grants from the Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior . Dr. DeOliveira and Dr. Pawlik contributed equally to the production of this manuscript.

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Correspondence to Michael A. Choti.

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DISCUSSION

Bruce D. Schirmer, M.D. (Charlottesville, Vir): Did you actually look at the histology of the metastatic lesions themselves? In other differentiated and perhaps had tumor necrosis as a reason for their hypoechoicness?

Michelle DeOliveira, M.D. (Baltimore, Md): Dr. Shirmer, thank you very much for your question regarding a possible correlation between histology and echogenicity of the liver metastases. Indeed, we evaluated the histology, but failed to identify significant correlation as moderated or poorly differentiated tumors were similarly distributed in the three types of echogenicity.

David M. Nagorney, M.D. (Rochester, Minn): Isn’t echogenicity relative? It is relative to the surrounding liver that you are looking at. Did you look at the texture and echogenicity of the regular liver and compare this also to outcomes?

Dr. DeOliveira: Thank you very much, Dr. Nagorney, for your important question about the interpretation of the echogenicity of the liver lesions. Yes, the echogenicity of lesions depend not only on the tumor characteristic but also on the surrounding liver. We tried to characterize the surrounding liver regarding features such as steatosis, ect. We could not find any influence of variable echogenicity of the surrounding tissue on our results.

J. Nicolas Vauthey, M.D. (Houston, Tex): You looked at preoperative chemotherapy as a possible factor. I was wondering about the type of chemotherapy agents you included in the preoperative chemotherapy group? As you know, there is quite a difference between preoperative chemotherapy, with just 5-FU, which does not induce a significant response in liver metastases, and the other end of the spectrum, FOLFOX or FOLFIRI with bevacizumab, where we really see a loss of vascular enchancement of the lesions.

Dr. DeOliveira: Thank you very much, Dr. Vauthey, for your remark. This is an important point. We report on the use of chemotherapy but did not stratify for the specific agents. We plan to analyze the effects of FOLFOX or FOLFIRI relationship to echogenicity.

Howard S. Kaufman, M.D. Michelle, one final question. You have told us about a phenotype, which is echogenicity as a prognostic factor. Your group has done some work in the past with molecular markers. Have you looked at the genetics of these tumors to see if there is a genetic expression or a genetic correlation with echogenicity?

Dr. DeOliveira: Thank you, Dr. Kaufman, for this question. We have not yet studied molecular markers in this set of patients and the relationship of echogenicity.

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DeOliveira, M.L., Pawlik, T.M., Gleisner, A.L. et al. Echogenic Appearance of Colorectal Liver Metastases on Intraoperative Ultrasonography is Associated with Survival After Hepatic Resection. J Gastrointest Surg 11, 970–976 (2007). https://doi.org/10.1007/s11605-007-0093-3

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