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Utility of Image Guidance in the Localization of Disappearing Colorectal Liver Metastases

  • Linda M. Pak
  • Johan Gagnière
  • Peter J. Allen
  • Vinod P. Balachandran
  • Michael I. D’Angelica
  • Ronald P. DeMatteo
  • William R. Jarnagin
  • Michael I. Miga
  • Amber L. Simpson
  • T. Peter KinghamEmail author
Original Article
  • 41 Downloads

Abstract

Background

Colorectal liver metastases that demonstrate a complete radiographic response during chemotherapy are increasingly common with advances in chemotherapy regimens and are described as disappearing liver metastases (DLMs). However, these DLMs often continue to harbor residual viable tumor. If these tumors are found in the operating room with ultrasound (US), they should be treated. The intraoperative sonographic visualization of these lesions, however, can be hindered by chemotherapy-associated liver parenchyma changes. The objective of this study was to evaluate the use of an intraoperative image guidance system, Explorer (Analogic Corporation, Peabody, MA), to aid surgeons in the identification of DLMs initially undetected by US alone.

Study Design

In a single-arm prospective trial, patients with colorectal liver metastases undergoing liver resection and/or ablation with one or more DLMs during neoadjuvant chemotherapy were enrolled. Intraoperatively, DLMs were localized with conventional US. Any DLM not found by conventional US was re-evaluated with the image guidance system. The primary outcome was the proportion of sonographically occult DLMs subsequently located by image-guided US.

Results

Between April 2016 and November 2017, 25 patients with 61 DLMs were enrolled. Thirty-eight DLMs (62%) in 14 patients (56%) were not identified with US alone. Six (16%) DLMs in five patients (36%) were subsequently located with assistance of the image guidance system. The image guidance changed the intraoperative surgical plan in four of these patients.

Conclusions

Image guidance can aid surgeons in the identification of initially sonographically occult DLMs and facilitate the complete surgical clearance of all sites of liver disease.

Keywords

Image-guided surgery Liver surgery Navigated ultrasound Surgical navigation Tracked ultrasound 

Notes

Author Contributions

LMP contributed to study conception and design, data acquisition, analysis, and interpretation; manuscript drafting and revision; and final approval of this version for publication, and agrees to be accountable for all aspects of this work. JG contributed to data acquisition, analysis, and interpretation; manuscript drafting and revision; and final approval of this version for publication, and agrees to be accountable for all aspects of this work. PJA, VPB, MID, RPD, and WRJ contributed to study design, data acquisition, and interpretation; manuscript drafting and revision; and final approval of this version for publication, and agree to be accountable for all aspects of this work. MIM contributed to study conception, data interpretation, manuscript revision, and final approval of this version for publication, and agrees to be accountable for all aspects of this work. ALS and TPK contributed to study conception and design, data acquisition, analysis, and interpretation; manuscript drafting and revision; and final approval of this version for publication, and agree to be accountable for all aspects of this work.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Linda M. Pak
    • 1
  • Johan Gagnière
    • 1
    • 2
    • 3
  • Peter J. Allen
    • 1
    • 4
  • Vinod P. Balachandran
    • 1
  • Michael I. D’Angelica
    • 1
  • Ronald P. DeMatteo
    • 1
    • 5
  • William R. Jarnagin
    • 1
  • Michael I. Miga
    • 6
  • Amber L. Simpson
    • 1
  • T. Peter Kingham
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Digestive and Hepatobiliary SurgeryUniversity Hospital of Clermont-FerrandClermont-FerrandFrance
  3. 3.U1071 INSERM/University Clermont AuvergneClermont-FerrandFrance
  4. 4.Department of SurgeryDuke UniversityDurhamUSA
  5. 5.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of Biomedical EngineeringVanderbilt UniversityNashvilleUSA

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