Annals of Surgical Oncology

, Volume 16, Issue 5, pp 1247–1253 | Cite as

Impact of Chemotherapy on the Accuracy of Computed Tomography Scan for the Evaluation of Colorectal Liver Metastases

  • Benjamin Angliviel
  • Stéphane Benoist
  • Christophe Penna
  • Mostafa El Hajjam
  • Sophie Chagnon
  • Catherine Julié
  • Alain Beauchet
  • Philippe Rougier
  • Bernard Nordlinger
Gastrointestinal Oncology



The aim of this study was to determine the effect of chemotherapy on the accuracy of CT scan for the preoperative evaluation of colorectal liver metastases (LM).


Between 1999 and 2005, 92 patients with less than six LM at diagnosis underwent surgery within four weeks of CT scan. Of these 92 patients, 60 had received chemotherapy before surgery (chemotherapy group), whereas 32 were operated without preoperative treatment (control group). Histological and surgical findings were compared with helical CT results.


On a per lesion basis, the sensitivity of CT scan for the detection of LM was 71% in the chemotherapy group and 76% in the control group. On a per patient basis, the sensitivity of CT scan was 54% in the chemotherapy group and 69% in the control group. Discrepancies between CT scan and surgical or histological findings, including both false-negative and false-positive lesions, were found in 32 patients from the chemotherapy group and 10 patients from the control group (p=0.0471). In multivariate analysis, chemotherapy (p=0.032), number of LM > 3 (p=0.034), and steatosis > 30% (p=0.012) were risk factors for inadequate staging of LM by CT scan.


Chemotherapy reduces the accuracy of CT scan for preoperative evaluation of colorectal LM.


Compute Tomographic Liver Metastasis Liver Resection Colorectal Liver Metastasis Helical Compute Tomographic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This trial was supported by grants from the AROLD association


  1. 1.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Scheele J. Hepatectomy for liver metastases. Br J Surg. 1993;80:274–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Petrelli NJ, Abbruzzese J, Mansfield P, Minsky B. Hepatic resection: the last surgical frontier for colorectal cancer. J Clin Oncol. 2005;23:4475–7.PubMedGoogle Scholar
  4. 4.
    Meric F, Patt YZ, Curley SA, et al. Surgery after downstaging of unresectable hepatic tumors with intra-arterial chemotherapy. Ann Surg Oncol. 2000;7:490–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Allen PJ, Kemeny N, Jarnagin W, DeMatteo R, Blumgart L, Fong Y. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.PubMedCrossRefGoogle Scholar
  8. 8.
    Nordlinger B, Benoist S. Benefits and risks of neoadjuvant therapy for liver metastases. J Clin Oncol. 2006;24:4954–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg. 2006;243:1–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006;24:2065–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Parikh AA, Gentner B, Wu TT, et al. Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg. 2003;7:1082–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Bilchik AJ, Poston G, Curley SA, et al. Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol. 2005;23:9073–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol. 2004;15:460–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Fernandez FG, Ritter J, Goodwin JW, et al. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg. 2005;200:845–53.PubMedCrossRefGoogle Scholar
  15. 15.
    de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMedGoogle Scholar
  16. 16.
    Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355:1041–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Bipat S, van Leeuwen MS, Comans EF, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology. 2005;237:123–31.PubMedCrossRefGoogle Scholar
  18. 18.
    Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002;224:748–56.PubMedCrossRefGoogle Scholar
  19. 19.
    Bhattacharjya S, Bhattacharjya T, Baber S, et al. Prospective study of contrast-enhanced computed tomography, computed tomography during arterioportography, and magnetic resonance imaging for staging colorectal liver metastases for liver resection. Br J Surg. 2004;91:1361–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Valls C, Andia E, Sanchez A, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology. 2001;218:55–60.PubMedGoogle Scholar
  21. 21.
    Benoist S, Brouquet A, Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Lubezky N, Metser U, Geva R, et al. 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. 2007;11:472–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Peppercorn PD, Reznek RH, Wilson P, Slevin ML, Gupta RK. Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. Br J Cancer. 1998;77:2008–11.PubMedGoogle Scholar
  24. 24.
    Miyake K, Hayakawa K, Nishino M, Morimoto T, Mukaihara S. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. Acad Radiol. 2005;12:722–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Cho CS, Curran S, Schwartz LH, et al. Preoperative radiographic assessment of hepatic steatosis with histologic correlation. J Am Coll Surg. 2008;206:480–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Robinson PJ. Imaging liver metastases: current limitations and future prospects. Br J Radiol. 2000;73:234–41.PubMedGoogle Scholar
  27. 27.
    Tang-Barton P, Vas W, Weissman J, et al. Focal fatty liver lesions in alcoholic liver disease: a broadened spectrum of CT appearances. Gastrointest Radiol. 1985;10:133–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Yates CK, Streight RA. Focal fatty infiltration of the liver simulating metastatic disease. Radiology. 1986;159:83–4.PubMedGoogle Scholar
  29. 29.
    Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.PubMedCrossRefGoogle Scholar
  30. 30.
    Rivoire M, De Cian F, Meeus P, et al. Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma. Cancer. 2002;95:2283–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Bartolozzi C, Donati F, Cioni D, et al. Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol. 2004;14:14–20.PubMedCrossRefGoogle Scholar
  32. 32.
    Sahani DV, Kalva SP, Tanabe KK, et al. Intraoperative US in patients undergoing surgery for liver neoplasms: comparison with MR imaging. Radiology. 2004;232:810–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Ward J, Robinson PJ, Guthrie JA, et al. Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology. 2005;237:170–80.PubMedCrossRefGoogle Scholar
  34. 34.
    Piscaglia F, Corradi F, Mancini M, et al. Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer. BMC Cancer. 2007;7:171.PubMedCrossRefGoogle Scholar
  35. 35.
    Konopke R, Bunk A, Kersting S. The role of contrast-enhanced ultrasound for focal liver lesion detection: an overview. Ultrasound Med Biol. 2007;33:1515–26.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Benjamin Angliviel
    • 1
    • 2
  • Stéphane Benoist
    • 1
    • 2
  • Christophe Penna
    • 1
    • 2
  • Mostafa El Hajjam
    • 2
    • 3
  • Sophie Chagnon
    • 2
    • 3
  • Catherine Julié
    • 2
    • 4
  • Alain Beauchet
    • 2
    • 5
  • Philippe Rougier
    • 2
    • 6
  • Bernard Nordlinger
    • 1
    • 2
  1. 1.Department of SurgeryAP-HP, Hôpital Ambroise ParéBoulogneFrance
  2. 2.Université Versailles Saint Quentin en YvelinesVersaillesFrance
  3. 3.Department of RadiologyAP-HP, Hôpital Ambroise ParéBoulogneFrance
  4. 4.Department of PathologyAP-HP, Hôpital Ambroise ParéBoulogneFrance
  5. 5.Biostatistical DepartmentAP-HP, Hôpital Ambroise ParéBoulogneFrance
  6. 6.Department of Gastroenterology and OncologyAP-HP, Hôpital Ambroise Paré BoulogneFrance

Personalised recommendations