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Patient Tailored Resection Planning in Patients Undergoing Liver Surgery for Colorectal Liver Metastases; How and Why Should You Do It?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

A systematic preoperative evaluation to determine the individual resection strategy in patients with colorectal liver metastases (CRLM) was assessed as to its clinical value.

Patients and Methods

From 2009 to 2011, 75 patients with CRLM who were scheduled for surgery were prospectively included and received an additional preoperative systematic evaluation in the presence of a hepatobiliary radiologist and the hepatobiliary surgeon scheduled to perform the surgery. The following items were assessed in a standardized manner: lesion detection and characterization, presence of extrahepatic disease, vascular anatomy, and resection strategy. Intraoperative findings and histopathological results were prospectively recorded.

Results

Five out of 75 patients were not considered to be eligible for surgery due to additional findings, such as additional metastases or extrahepatic disease. Sensitivity and specificity for detection of individual CRLM were 80.9 % (95 % CI 75.7–86.1 %) and 69.1 % (95% CI 59.1–79.1 %), respectively. Radical resections were performed in 87.1 %. There was one futile laparotomy (1.4 %).

Conclusion

In patients with colorectal liver metastases, standardized preoperative work-up, with subsequent planning of an individualized resection in a jointed meeting of a hepatobiliary radiologist and the surgeon who will perform the operation, leads to a high level of radical resections and a low number of futile laparotomies.

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Authors and Affiliations

  1. Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands

    C. S. van Kessel, M. S. van Leeuwen & M. A. A. J. van den Bosch

  2. Department of Surgery, University Medical Centre Utrecht, G04.228 Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    C. S. van Kessel, R. van Hillegersberg, I. H. M. Borel Rinkes & I. Q. Molenaar

Authors
  1. C. S. van Kessel
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  2. M. S. van Leeuwen
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  3. R. van Hillegersberg
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  4. I. H. M. Borel Rinkes
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  5. M. A. A. J. van den Bosch
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  6. I. Q. Molenaar
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Corresponding author

Correspondence to C. S. van Kessel.

Appendix

Appendix

Scoreform 1. Preoperative imaging of patients who are scheduled for liver surgery

figure a

Scoreform 2. Preoperative evaluation of liver vasculature

figure b

Scoreform 3. Resection strategy following expert meeting

figure c

Scoreform 4. Intraoperative ultrasound

figure d

Scoreform 5. Histopathology

figure e

*Central necrosis, no viable tumor cells, etc.

Scoreform 6. Follow-up after surgery

figure f

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van Kessel, C.S., van Leeuwen, M.S., van Hillegersberg, R. et al. Patient Tailored Resection Planning in Patients Undergoing Liver Surgery for Colorectal Liver Metastases; How and Why Should You Do It?. J Gastrointest Surg 17, 1836–1849 (2013). https://doi.org/10.1007/s11605-013-2185-6

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  • DOI: https://doi.org/10.1007/s11605-013-2185-6

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