Surgical Endoscopy

, Volume 5, Issue 1, pp 36–40 | Cite as

Intraoperative ultrasonographic detection of occult liver metastases in colorectal cancer

  • J. Stadler
  • A. H. Hölscher
  • J. Adolf
Original Articles


The efficacy of intraoperative ultrasonographic detection of colorectal cancer liver metastases was evaluated in 85 patients undergoing operation for primary colorectal tumors or liver secondaries. The results of intraoperative ultrasonography were compared with those of preoperative ultrasonography and computed tomography, as well as the intraoperative appearances of the liver. Additional information about the number of metastases was obtained in 12 cases (14.1%); 17 (24.3%) out of 70 metastases could only be detected by intraoperative ultrasonography. In 4 cases (4.7%) these lesions were solitary. As a result, the operative procedure of choice was changed in 15.3% of the patients. We conclude that intraoperative ultrasonography has a significantly higher ability to detect colorectal cancer liver metastases than preoperative methods or intraoperative inspection and palpation. Intraoperative ultrasonography should be performed in patients without preoperative evidence of liver metastases and in all patients with planned resection of metastases.

Key words

Colorectal cancer Liver metastases Intraoperative ultrasonography Preoperative ultrasonography Computed tomography 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adson MA, Heerden JA van, Adson MH, Wagner JS, Ilstrup DM (1984) Resection of hepatic metastases from colorectal cancer. Arch Surg 119: 647–651Google Scholar
  2. 2.
    Alderson PO, Adams BS, McNeal BJ (1983) Computer tomography, ultrasound and scintigraphy of the liver in patients with colon carcinoma: prospective comparison. Radiology 149: 225–230Google Scholar
  3. 3.
    Balch CM, Urist MM, Soong SJ, McGregor M (1983) A prospective phase II clinical trial of continous FUDR regional chemotherapy for colorectal metastases to the liver using a totally implantable drug infusion pump. Ann Surg 198: 567–573Google Scholar
  4. 4.
    Bengmark S, Hafstrom L (1966) The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal cancer at laparotomy. Cancer 23: 198–202Google Scholar
  5. 5.
    Bengtsson G, Karlsson G, Havstrom L, Jonsson E (1981) Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141: 586–589Google Scholar
  6. 6.
    Bismuth H, Castaing D, Gordon OJ (1987) The use of operative ultrasound in surgery of primary liver tumors. World J Surg 11: 610–614Google Scholar
  7. 7.
    Boldrini G, deGaetano AM, Giovanni K, Castagneto M, Colagrande C, Castiglioni G (1987) The systematic use of operative ultrasound for detection of liver metastases during colorectal surgery. World J Surg 11: 622–627Google Scholar
  8. 8.
    Butler J, Attiyeh SS, Daly JM (1986) Hepatic resection for metastases of the colon and rectum. Surg Gynecol Obstet 162: 109–113Google Scholar
  9. 9.
    Cady D, McDermott WV (1985) Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 201: 204–209Google Scholar
  10. 10.
    Castaing D, Emont J, Kunstlinger F, Bismuth H (1986) Utility of operative ultrasound in the surgical management of liver tumors. Ann Surg 204: 600–605Google Scholar
  11. 11.
    Charnely RM, Morris DL, Dennison HR, Griffith CDN, Amar FS, Hardcastle JD (1988) Intraoperative ultrasound: more accurate staging of colorectal cancer (abstract). Surg Endosc 2: 112Google Scholar
  12. 12.
    Coppa GS, Eng K, Ranson JHC, Gouge TH, Localio SA (1985) Hepatic resection for metastatic colon and rectal cancer. Ann Surg 202: 203–208Google Scholar
  13. 13.
    Couinaud C (1957) Le foie études anatomiques et chirurgicales. Masson, ParisGoogle Scholar
  14. 14.
    Deixonne B, Lopez FM (1988) Operative ultrasonography during hepatobiliary and pancreatic surgery. Springer, Berlin Heidelberg New YorkGoogle Scholar
  15. 15.
    Finlay IG, Mc Ardle CS (1986) Occult hepatic metastases of colorectal carcinoma. Br J Surg 73: 732–735Google Scholar
  16. 16.
    Finlay IG, Meek WR, Gray HW (1982) Incidence and detection of occult hepatic metastases in colorectal carcinoma. Br Med J 284: 803–805Google Scholar
  17. 17.
    Gianola SJ, Dwyer A, Jones AE, Sugarbaker PH (1984) Prospective studies of laboratory and radiologic tests in the management of colon and rectal cancer. Dis Colon Rectum 27: 806–818Google Scholar
  18. 18.
    Goligher JC (1941) The operability of carcinoma of the rectum. Br Med J II: 393–397Google Scholar
  19. 19.
    Greenway B (1988) Hepatic metastases from colorectal cancer: resection or not. Br J Surg 75: 513–519Google Scholar
  20. 20.
    Iwazuki S, Shaw BW, Starzl TE (1983) Experience with 115 liver resections. Ann Surg 197: 247–253Google Scholar
  21. 21.
    Kemeny MM, Hogan JN, Ganteaune L, Goldberg DA, Terz JJ (1986) Preoperative staging with computerized axial tomography and biochemical laboratory tests in patients with hepatic metastases. Ann Surg 203: 169–172Google Scholar
  22. 22.
    Klotter HJ, Sattler J, Rothmund M (1988) Intraoperative sonography with surgical liver disease. Surg Endosc 2: 142–143Google Scholar
  23. 23.
    Machi J, Isomoto H, Kurohiji T, Shirouzu K, Yamashida Y, Kakegawa T, Sigel B (1986) Detection of unrecognized liver metastases from colorectal cancer by routine use of ultrasonography. Dis Colon Rectum 29: 405–409Google Scholar
  24. 24.
    Machi J, Isomoto H, Yamashita Y, Kurohiji T, Shirouzu K, Kakegawa T (1987) Intraoperative ultrasonography in screening for liver metastases from colorectal cancer. Comparative accuracy with traditional procedures. Surgery 101: 678–684Google Scholar
  25. 25.
    Makuuchi M (1987) Abdominal intraoperative ultrasonography. Igaku-Shoin, Tokyo New YorkGoogle Scholar
  26. 26.
    Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161: 246–250Google Scholar
  27. 27.
    Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K, Moriyama N (1985) The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma. World J Surg 11: 615–621Google Scholar
  28. 28.
    Mooney B, Critchlesy M, Grime S, Taylor I (1981) Portal vein liver scanning for early detection of liver metastases in colorectal cancer (abstract). Gut 25 a: 436Google Scholar
  29. 29.
    Oxley EN, Ellis H (1969) Prognosis of carcinoma of the large bowel in the presence of liver metastases. Br J Surg 56: 149–152Google Scholar
  30. 30.
    Rich JA, Dailey JM (1985) Treatment of colorectal hepatic metastases. Surg Gynecol Obstet 161: 597–607Google Scholar
  31. 31.
    Riether RD, Khubghandani ET, Sheets JA, Stasik JJ, Rosen L (1985) A prospective study of continuous hepatic perfusion with implantable pump. Dis Colon Rectum 28: 24–26Google Scholar
  32. 32.
    Smith TJ, Kemeny NN, Sugarbaker PH (1982) A prospective study of hepatic imaging in the detection of metastatic disease. Ann Surg 195: 486–491Google Scholar
  33. 33.
    Temple DF, Parthasarathy KL, Bakshi SP, Mittelman AE (1983) A comparison of isotopic and computerized tomographic scanning in the diagnosis of metastases of the liver in patients with adenocarcinoma of the colon and rectum. Surg Gynecol Obstet 156: 205–208Google Scholar
  34. 34.
    Thomas WM, Morris D, Hardcastle JD (1987) Contest ultrasonography in the detection of liver metastases from colorectal cancer. An in vitro study. Br J Surg 74: 955–956Google Scholar
  35. 35.
    Ward BA, Miller DL, Frank JA, Dwyer AJ, Simmons JT, Chang R, Shawker THH, Choyke P, Chang AE (1989) Prospective evaluation of hepatic imaging studies in detection of colorectal metastases: correlation with surgical findings. Surgery 105: 180–187Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • J. Stadler
    • 1
  • A. H. Hölscher
    • 1
  • J. Adolf
    • 1
  1. 1.Chirurgische Klinik und Poliklinik der Technischen Universität, Klinikum rechts der IsarMünchen 80Federal Republic of Germany

Personalised recommendations