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Intraoperative Liver Ultrasound Still Affects Surgical Strategy for Patients with Colorectal Metastases in the Modern Era

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Abstract

Background

The present study was designed to evaluate the role of intraoperative ultrasound (IOUS) in intrahepatic staging and the impact on surgical strategy for patients with colorectal liver metastases (CRLM).

Methods

The study included 515 patients who had undergone liver resection for CRLM at two tertiary care referral centers. Data from a prospectively collected database were retrospectively analysed. Early intrahepatic recurrence was assessed at 3 and 6 months after resection and was considered as residual disease undetected by IOUS. Performance of imaging modalities was compared by analysis of studies on individual patients.

Results

A total of 1,370 liver metastases were detected preoperatively with a median of 3 imaging modalities. MRI and PET were performed in 51 and 42 % of the patients, respectively. Median number of days between last imaging and surgery was 18. Contrast-enhanced IOUS was performed in 136 patients (26.4 %). Intraoperatively, 293 new nodules were found in 132 patients: on histology 280 were CRLM (17.6 %). Surgical strategy was changed in 140 patients (27.2 %). On multivariate analysis synchronous and bilobar metastases ≥3 in number, BMI ≥30, and time between last imaging and surgery longer than 18 days resulted in predictive factors indicating new nodules detected by IOUS. Early intrahepatic recurrences were 3.7 and 7.9 % at 3 and 6 months. Performance of CT, MRI, FDG-PET, and intraoperative staging was compared: sensitivity was 63.6, 68.8, 53.6, and 92 % and specificity was 91, 92.3, 95.8, and 97.8 %, respectively

Conclusions

The use of IOUS continues to be mandatory for correct staging of patients with CRLM undergoing liver resection.

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References

  1. Makuuchi M, Hasegawa H, Yamazaki S et al (1987) Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet 164:68–72

    PubMed  CAS  Google Scholar 

  2. Cervone A, Sardi A, Conaway GL (2000) Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions. Am Surg 66:611–615

    PubMed  CAS  Google Scholar 

  3. Rydzewski B, Dehdashti F, Gordon BA et al (2002) Usefulness of intraoperative sonography for revealing hepatic metastases from colorectal cancer in patients selected for surgery after undergoing FDG-PET. AJR Am J Roentgenol 178:353–358

    Article  PubMed  Google Scholar 

  4. Conlon R, Jacobs M, Dasgupta D et al (2003) The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging. Eur J Ultrasound 16:211–216

    Article  PubMed  Google Scholar 

  5. Torzilli G, Botea F, Procopio F et al (2008) Use of contrast-enhanced intraoperative ultrasonography during liver surgery for colorectal liver cancer metastases: its impact on operative outcome analysis of a prospective cohort study. Eur J Cancer 6:16–23

    Google Scholar 

  6. Sietses C, Meijerink MR, Meijer S et al (2010) The impact of intraoperative ultrasonography on the surgical treatment of patients with colorectal liver metastases. Surg Endosc 24:1917–1922

    Article  PubMed  CAS  Google Scholar 

  7. van Vledder MG, Pawlik TM, Munireddy S et al (2010) Factors determining the sensitivity of intraoperative ultrasonography in detecting colorectal liver metastases in the modern era. Ann Surg Oncol 17:2756–2763

    Article  PubMed  Google Scholar 

  8. Hata S, Imamura H, Aoki T et al (2011) Value of visual inspection, bimanual palpation, and intraoperative ultrasonography during hepatic resection for liver metastases of colorectal carcinoma. World J Surg 35:2779–2787. doi:10.1159/000346421

    Article  PubMed  Google Scholar 

  9. D’Hondt M, Vandenbroucke-Menu F, Préville-Ratelle S et al (2011) Is intra-operative ultrasound still useful for the detection of a hepatic tumour in the era of modern pre-operative imaging? HPB (Oxford) 13:665–669

    Article  Google Scholar 

  10. Tamandl D, Herberger B, Gruenberger B et al (2008) Adequate preoperative staging rarely leads to a change of intraoperative strategy in patients undergoing surgery for colorectal cancer liver metastases. Surgery 143:648–657

    Article  PubMed  Google Scholar 

  11. Wagnetz U, Atri M, Massey C et al (2011) Intraoperative ultrasound of the liver in primary and secondary hepatic malignancies: comparison with preoperative 1.5-T MRI and 64-MDCT. AJR Am J Roentgenol 196:562–568

    Article  PubMed  Google Scholar 

  12. Terminology Committee of The International Hepato-Pancreato-Biliary Association (2000) The Brisbane 2000 terminology of liver anatomy and resection. HPB 2:333–339

    Google Scholar 

  13. Kleiner DE, Brunt EM, Van Natta M et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 4:1313–1321

    Article  Google Scholar 

  14. Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318

    Article  PubMed  CAS  Google Scholar 

  15. Choti MA, Kaloma F, de Oliveira ML et al (2008) Patient variability in intraoperative ultrasonographic characteristics of colorectal liver metastases. Arch Surg 143:29–34

    Article  PubMed  Google Scholar 

  16. DeOliveira ML, Pawlik TM, Gleisner AL et al (2007) Echogenic appearance of colorectal liver metastases on intraoperative ultrasonography is associated with survival after hepatic resection. J Gastrointest Surg 11:970–976

    Article  PubMed  Google Scholar 

  17. Donadon M, Botea F, Del Fabbro D et al (2008) The surgical policy predicts the impact of contrast enhanced intraoperative ultrasound for colorectal liver metastases. Eur J Radiol 67:177–178

    Article  PubMed  Google Scholar 

  18. Wiering B, Ruers TJ, Krabbe P et al (2007) Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Ann Surg Oncol 14:818–826

    Article  PubMed  CAS  Google Scholar 

  19. Abdalla EK, Denys A, Chevalier P et al (2004) Total and segmental liver volume variations: implications for liver surgery. Surgery 135:404–410

    Article  PubMed  Google Scholar 

  20. Foroutani A, Garland AM, Berber E et al (2000) Laparoscopic ultrasound vs triphasic computed tomography for detecting liver tumors. Arch Surg 135:933–938

    Article  PubMed  CAS  Google Scholar 

  21. Torzilli G, Del Fabbro D, Palmisano A et al (2005) Contrast-enhanced intraoperative ultrasonography during hepatectomies for colorectal cancer liver metastases. J Gastrointest Surg 9:1148–1153

    Article  PubMed  Google Scholar 

  22. Leen E, Ceccotti P, Moug SJ et al (2006) Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases: an essential investigation before resection? Ann Surg 243:236–240

    Article  PubMed  Google Scholar 

  23. Viganò L, Ferrero A, Amisano M et al (2012) Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 100:535–542

    Article  Google Scholar 

  24. Robinson PJA (2009) The effects of cancer chemotherapy on liver imaging. Eur Radiol 19:1752–1762

    Article  PubMed  Google Scholar 

  25. Uppot RN (2007) Impact of obesity on radiology. Radiol Clin North Am 45:231–246

    Article  PubMed  Google Scholar 

  26. Torzilli G, Makuuchi M (2003) Intraoperative ultrasonography in liver cancer. Surg Oncol Clin North Am 12:91–103

    Article  Google Scholar 

  27. Bipat S, van Leewen MS, Comans EFI et al (2005) Colorectal liver metastases: CT, MR imaging and PET for diagnosis–meta-analysis. Radiology 237:123–131

    Article  PubMed  Google Scholar 

  28. Floriani I, Torri V, Rulli E et al (2010) Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 31:19–31

    Article  PubMed  Google Scholar 

  29. Kulemann V, Schima W, Tamandl D et al (2011) Preoperative detection of colorectal liver metastases: MDCT or MRI? Eur J Radiol 79:1–6

    Article  Google Scholar 

  30. Lordan JT, Stenson KM, Karanjia ND (2011) The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer. Ann R Coll Surg Engl 93:246–249

    Article  PubMed  Google Scholar 

  31. Lubezky N, Metser U, Geva R et al (2007) The role and limitations of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and computerized tomography (CT) in restaging patients with hepatic colorectal metastases following neoadjuvant chemotherapy: comparison with operative and pathological findings. J Gastrointest Surg 11:472–478

    Article  PubMed  Google Scholar 

  32. Akhurst T, Kates TJ, Mazumdar M et al (2005) Recent chemotherapy reduces the sensitivity of [18F] fluorodeoxyglucose positron emission tomography in the detection of colorectal metastases. J Clin Oncol 23:8713–8716

    Article  PubMed  Google Scholar 

  33. Adie S, Yip C, Chu F et al (2009) Resection of liver metastases from colorectal cancer: does preoperative chemotherapy affect the accuracy of PET in preoperative planning? ANZ J Surg 79:358–361

    Article  PubMed  Google Scholar 

  34. Wildi SM, Gubler C, Hany T et al (2008) Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG-PET-CT. J Clin Ultrasound 36:20–26

    Article  PubMed  Google Scholar 

  35. van Kessel CS, Buckens CF, van den Bosch MA et al. (2012) Preoperative imaging of colorectal liver metastases after neoadjuvant chemotherapy: a meta-analysis. Ann Surg Oncol Mar 7 [Epub ahead of print] doi: 10.1245/s10434-012-2300-z

  36. Knowles B, Welsh FK, Chandrakumaran K et al (2012) Detailed liver-specific imaging prior to pre-operative chemotherapy for colorectal liver metastases reduces intra-hepatic recurrence and the need for a repeat hepatectomy. HPB (Oxford) 14:298–309

    Article  Google Scholar 

  37. Regge D, Campanella D, Anselmetti GC et al (2006) Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma. Clin Radiol 61:338–347

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati 62, 10128, Turin, Italy

    Alessandro Ferrero, Serena Langella, Luca Viganò, Giuseppe Zimmitti & Lorenzo Capussotti

  2. Unit of Hepato-biliary Surgery, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Felice Giuliante, Maria Vellone, Francesco Ardito & Gennaro Nuzzo

Authors
  1. Alessandro Ferrero
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  2. Serena Langella
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  3. Felice Giuliante
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  4. Luca Viganò
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  5. Maria Vellone
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  6. Giuseppe Zimmitti
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  7. Francesco Ardito
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  8. Gennaro Nuzzo
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  9. Lorenzo Capussotti
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Correspondence to Alessandro Ferrero.

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Ferrero, A., Langella, S., Giuliante, F. et al. Intraoperative Liver Ultrasound Still Affects Surgical Strategy for Patients with Colorectal Metastases in the Modern Era. World J Surg 37, 2655–2663 (2013). https://doi.org/10.1007/s00268-013-2183-6

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  • DOI: https://doi.org/10.1007/s00268-013-2183-6

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