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Intraoperative Contrast-Enhanced Ultrasound in Colorectal Liver Metastasis Surgery Improves the Identification and Characterization of Nodules

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Abstract

Introduction

The sensitivity of preoperative assessment of colorectal liver metastases (CRLM) ranges from 74 to 80 %. Intraoperative ultrasound (IOUS) associated with contrast-enhanced intraoperative ultrasound (CE-IOUS) may be able to improve this. Thus, the aims of this study were to assess the value of IOUS and CE-IOUS for the surgical approach and to determine risk factors both for the detection of new nodules and for the modification of the surgical strategy.

Materials and methods

Forty-three patients who underwent CRLM surgery were included. These patients had an MRI in the 8 weeks preceding surgery and benefited from intraoperative IOUS and CE-IOUS.

Results and discussion

The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.

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Acknowledgments

The authors wish to thank Mr Kevin Erwin for his kind help in the English revision of the manuscript.

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Author notes

    Authors and Affiliations

    1. Department of Radiology, CHU d’Angers, LUNAM University, 4 rue Larrey, 49933, Angers Cedex, France

      Julien Hoareau, Jérôme Lebigot & Christophe Aube

    2. Department of Visceral Surgery, CHU d’Angers, LUNAM University, 4 rue Larrey, 49933, Angers Cedex, France

      Aurélien Venara & Emilie Lermite

    3. Department of Biostatistics and Methodology, CHU d’Angers, LUNAM University, 4 rue Larrey, 49933, Angers Cedex, France

      Jean-Francois Hamel

    4. Department of Gastroenterology and Hepatology, CHU d’Angers, LUNAM University, 4 rue Larrey, 49933, Angers Cedex, France

      Francois Xavier Caroli-Bosc

    5. HIFIH Laboratory, LUNAM University, Université d’Angers, rue Haute-de-Reculée, 49045, Angers, France

      Christophe Aube

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    1. Julien Hoareau
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    Correspondence to Aurélien Venara.

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    Julien Hoareau and Aurélien Venara have contributed equally to this work.

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    Hoareau, J., Venara, A., Lebigot, J. et al. Intraoperative Contrast-Enhanced Ultrasound in Colorectal Liver Metastasis Surgery Improves the Identification and Characterization of Nodules. World J Surg 40, 190–197 (2016). https://doi.org/10.1007/s00268-015-3269-0

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    • DOI: https://doi.org/10.1007/s00268-015-3269-0

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