Echogenic Appearance of Colorectal Liver Metastases on Intraoperative Ultrasonography is Associated with Survival After Hepatic Resection
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
- Adam R, Vinet E. Regional treatment of metastasis: surgery of colorectal liver metastases. Ann Oncol 2004;15:103–106.
- Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990;77:1241–1246. CrossRef
- Sasaki A, Iwashita Y, Shibata K, Matsumoto T, Ohta M, Kitano S. Analysis of preoperative prognostic factors for long-term survival after hepatic resection of liver metastasis of colorectal carcinoma. J Gastrointest Surg 2005;9:374–380. CrossRef
- Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, Curley SA, Loyer EM, Muratore A, Mentha G, Capussotti L, Vauthey JN. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005;241:715–722, discussion 722–714. CrossRef
- Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, Lillemoe KD, Yeo CJ, Cameron JL. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002;235:759–766. CrossRef
- Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309–318, discussion 318–321. CrossRef
- Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996;77:1254–1262. CrossRef
- Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl TE. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 1994;116:703–710, discussion 710–701.
- Pawlik TM, Choti MA. Shifting from clinical to biologic indicators of prognosis after resection of hepatic colorectal metastases. Curr Colorectal Cancer Rep 2006;2:85–93. CrossRef
- Gruenberger T, Jourdan JL, Zhao J, King J, Morris DL. Echogenicity of liver metastases is an independent prognostic factor after potentially curative treatment. Arch Surg 2000;135:1285–1290. CrossRef
- Gruenberger T, Zhao J, King J, Chung T, Clingan PR, Morris DL. Echogenicity of liver metastases from colorectal carcinoma is an independent prognostic factor in patients treated with regional chemotherapy. Cancer 2002;94:1753–1759. CrossRef
- Seifert JK, Morris DL. Pretreatment echogenicity of colorectal liver metastases predicts survival after hepatic cryotherapy. Dis Colon Rectum 1999;42:43–49. CrossRef
- Soyer P, Mosnier H, Choti MA, Rymer R. Intraoperative and laparoscopic sonography of the liver. Eur Radiol 1997;7:1296–1302. CrossRef
- Choti MA, Kaloma F, de Oliveira ML, Nour S, Garrett-Mayer ES, Sheth S, Pawlik TM. Patient variability in intraoperative ultrasonographic characteristics of colorectal liver metastases. Arch Surg 2006 (in press).
- Rifkin MD, Rosato FE, Branch HM, Foster J, Yang SL, Barbot DJ, Marks GJ. Intraoperative ultrasound of the liver. An important adjunctive tool for decision making in the operating room. Ann Surg 1987;205:466–472. CrossRef
- Solomon MJ, Stephen MS, Gallinger S, White GH. Does intraoperative hepatic ultrasonography change surgical decision making during liver resection? Am J Surg 1994;168:307–310. CrossRef
- Gozzetti G, Mazziotti A, Bolondi L, Cavallari A, Grigioni W, Casanova P, Bellusci R, Villanacci V, Labo G. Intraoperative ultrasonography in surgery for liver tumors. Surgery 1986;99:523–530.
- Staren ED, Gambla M, Deziel DJ, Velasco J, Saclarides TJ, Millikan K, Doolas A. Intraoperative ultrasound in the management of liver neoplasms. Am Surg 1997;63:591–596, discussion 596–597.
- Luck AJ, Maddern GJ. Intraoperative abdominal ultrasonography. Br J Surg 1999;86:5–16. CrossRef
- Machi J, Sigel B, Zaren HA, Kurohiji T, Yamashita Y. Operative ultrasonography during hepatobiliary and pancreatic surgery. World J Surg 1993;17:640–645, discussion 645–646. CrossRef
- Zacherl J, Scheuba C, Imhof M, Zacherl M, Langle F, Pokieser P, Wrba F, Wenzl E, Muhlbacher F, Jakesz R, Steininger R. Current value of intraoperative sonography during surgery for hepatic neoplasms. World J Surg 2002;26:550–554. CrossRef
- Mann CD, Metcalfe MS, Leopardi LN, Maddern GJ. The clinical risk score: emerging as a reliable preoperative prognostic index in ultrasonographyhepatectomy for colorectal metastases. Arch Surg 2004;139:1168–1172. CrossRef
- Aldrighetti L, Castoldi R, Di Palo S, Arru M, Stella M, Orsenigo E, Gavazzi F, Ferla G, Di Carlo V, Staudacher C. Prognostic factors for long-term outcome of hepatic resection for colorectal liver metastases. Chir Ital 2005;57:555–570.
- Smith DL, Soria JC, Morat L, Yang Q, Sabatier L, Liu DD, Nemr RA, Rashid A, Vauthey JN. Human telomerase reverse transcriptase (hTERT) and Ki-67 are better predictors of survival than established clinical indicators in patients undergoing curative hepatic resection for colorectal metastases. Ann Surg Oncol 2004;11:45–51. CrossRef
- Domont J, Pawlik TM, Boige V, Rose M, Weber JC, Hoff PM, Brown TD, Zorzi D, Morat L, Pignon JP, Rashid A, Jaeck D, Sabatier L, Elias D, Tursz T, Soria JC, Vauthey JN. Catalytic subunit of human telomerase reverse transcriptase is an independent predictor of survival in patients undergoing curative resection of hepatic colorectal metastases: a multicenter analysis. J Clin Oncol 2005;23:3086–3093. CrossRef
- Mulcahy HE, Skelly MM, Husain A, O’Donoghue DP. Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 1996;83:46–50. CrossRef
- Umpleby HC, Ranson DL, Williamson RC. Peculiarities of mucinous colorectal carcinoma. Br J Surg 1985;72:715–718. CrossRef
- Echogenic Appearance of Colorectal Liver Metastases on Intraoperative Ultrasonography is Associated with Survival After Hepatic Resection
Journal of Gastrointestinal Surgery
Volume 11, Issue 8 , pp 970-976
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Colorectal metastases
- Intraoperative ultrasound
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Halsted 614, Baltimore, MD, 22187-6681, USA