Summary
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.
Similar content being viewed by others
References
Adson MA, Heerden JA van, Adson MH, Wagner JS, Ilstrup DM (1984) Resection of hepatic metastases from colorectal cancer. Arch Surg 119: 647–651
Alderson PO, Adams BS, McNeal BJ (1983) Computer tomography, ultrasound and scintigraphy of the liver in patients with colon carcinoma: prospective comparison. Radiology 149: 225–230
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: 567–573
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: 198–202
Bengtsson G, Karlsson G, Havstrom L, Jonsson E (1981) Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141: 586–589
Bismuth H, Castaing D, Gordon OJ (1987) The use of operative ultrasound in surgery of primary liver tumors. World J Surg 11: 610–614
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: 622–627
Butler J, Attiyeh SS, Daly JM (1986) Hepatic resection for metastases of the colon and rectum. Surg Gynecol Obstet 162: 109–113
Cady D, McDermott WV (1985) Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 201: 204–209
Castaing D, Emont J, Kunstlinger F, Bismuth H (1986) Utility of operative ultrasound in the surgical management of liver tumors. Ann Surg 204: 600–605
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: 112
Coppa GS, Eng K, Ranson JHC, Gouge TH, Localio SA (1985) Hepatic resection for metastatic colon and rectal cancer. Ann Surg 202: 203–208
Couinaud C (1957) Le foie études anatomiques et chirurgicales. Masson, Paris
Deixonne B, Lopez FM (1988) Operative ultrasonography during hepatobiliary and pancreatic surgery. Springer, Berlin Heidelberg New York
Finlay IG, Mc Ardle CS (1986) Occult hepatic metastases of colorectal carcinoma. Br J Surg 73: 732–735
Finlay IG, Meek WR, Gray HW (1982) Incidence and detection of occult hepatic metastases in colorectal carcinoma. Br Med J 284: 803–805
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: 806–818
Goligher JC (1941) The operability of carcinoma of the rectum. Br Med J II: 393–397
Greenway B (1988) Hepatic metastases from colorectal cancer: resection or not. Br J Surg 75: 513–519
Iwazuki S, Shaw BW, Starzl TE (1983) Experience with 115 liver resections. Ann Surg 197: 247–253
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: 169–172
Klotter HJ, Sattler J, Rothmund M (1988) Intraoperative sonography with surgical liver disease. Surg Endosc 2: 142–143
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: 405–409
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: 678–684
Makuuchi M (1987) Abdominal intraoperative ultrasonography. Igaku-Shoin, Tokyo New York
Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161: 246–250
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: 615–621
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: 436
Oxley EN, Ellis H (1969) Prognosis of carcinoma of the large bowel in the presence of liver metastases. Br J Surg 56: 149–152
Rich JA, Dailey JM (1985) Treatment of colorectal hepatic metastases. Surg Gynecol Obstet 161: 597–607
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: 24–26
Smith TJ, Kemeny NN, Sugarbaker PH (1982) A prospective study of hepatic imaging in the detection of metastatic disease. Ann Surg 195: 486–491
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: 205–208
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: 955–956
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: 180–187
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stadler, J., Hölscher, A.H. & Adolf, J. Intraoperative ultrasonographic detection of occult liver metastases in colorectal cancer. Surg Endosc 5, 36–40 (1991). https://doi.org/10.1007/BF00591385
Issue Date:
DOI: https://doi.org/10.1007/BF00591385