Skip to main content

Advertisement

SpringerLink
Log in

Positron Emission Tomography-Computed Tomography for Patients with Recurrent Colorectal Liver Metastases: Impact on Restaging and Treatment Planning

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The impact of fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) for patients with colorectal liver metastases (CLM) still is debated. Its relevance could be enhanced in the case of recurrent disease. The current study aimed to elucidate the role of PET-CT in restaging and treatment planning for recurrent CLM.

Methods

A series of 352 consecutive patients undergoing their first liver resection for CLM between 2005 and 2014 was reviewed. Of these patients, 224 (63.6 %) had a recurrence. The 107 patients who had received PET-CT at diagnosis of recurrence before chemotherapy were analyzed. CT was available in all cases, and magnetic resonance imaging (MRI) was available in 64 cases.

Results

Extrahepatic lesions were found in 59 patients. Liver and lung recurrences were detected with excellent sensitivity by CT/MRI and PET-CT (liver: 100 vs. 96.7 %; lung: 95.8 vs. 95.8 %). In detecting other recurrence sites, PET-CT had higher sensitivity than CT/MRI (91.5 vs. 54.2 %, p < 0.01; lymph nodes: 93.5 vs. 64.5 %, p = 0.011; peritoneum: 80 vs. 20 %, p = 0.023; bones: 87.5 vs. 37.5 %, nonsignificant difference). For 28.8 % (17/59) of the patients, the diagnosis of extrahepatic disease was obtained thanks to PET-CT (39.5 % considering nonpulmonary lesions). PET-CT modified treatment strategy in 16 (14.9 %) patients, excluding from surgery 15 (20.3 %) of 74 patients resectable at CT/MRI. This latter subgroup had a lower survival rate than the patients resectable after PET-CT (2-year survival, 22.7 vs. 77.8 %; p = 0.004), similar to the patients unresectable at CT/MRI (57.6 %).

Conclusions

In the authors’ experience, PET-CT has offered a relevant contribution to restaging of recurrent CLM. It disclosed one fourth of extrahepatic lesions and prevented worthless surgery for about 20 % of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Adam R, De Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Vauthey JN, Choti MA, Helton WS. AHPBA/SSO/SSAT Consensus Conference on hepatic colorectal metastases: rationale and overview of the conference. Ann Surg Oncol. 2006;13:1259–60.

    Article  PubMed  Google Scholar 

  3. Wicherts DA, de Haas RJ, Salloum C, et al. Repeat hepatectomy for recurrent colorectal metastases. Br J Surg. 2013;100:808–18.

    Article  CAS  PubMed  Google Scholar 

  4. Imamura H, Kawasaki S, Miyagawa S, Ikegami T, Kitamura H, Shimada R. Aggressive surgical approach to recurrent tumors after hepatectomy for metastatic spread of colorectal cancer to the liver. Surgery. 2000;127:528–35.

    Article  CAS  PubMed  Google Scholar 

  5. Viganò L, Capussotti L, Lapointe R, et al. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. a LiverMetSurvey-based study of 6025 patients. Ann Surg Oncol. 2014;21:1276–86.

    Article  PubMed  Google Scholar 

  6. Margonis GA, Spolverato G, Kim Y, Karagkounis G, Choti MA, Pawlik TM. Effect of KRAS mutation on long-term outcomes of patients undergoing hepatic resection for colorectal liver metastases. Ann Surg Oncol. 2015;22:4158–65.

    Article  PubMed  Google Scholar 

  7. Vauthey JN, Zimmitti G, Kopetz SE, et al. RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases. Ann Surg. 2013;258:619–26.

    Article  PubMed  Google Scholar 

  8. Carpizo DR, D’Angelica M. Liver resection for metastatic colorectal cancer in the presence of extrahepatic disease. Lancet Oncol. 2009;10:801–9.

    Article  PubMed  Google Scholar 

  9. Elias D, Ouellet JF, Bellon N, Pignon JP, Pocard M, Lasser P. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg. 2003;90:567–74.

    Article  CAS  PubMed  Google Scholar 

  10. Viganò L, Russolillo N, Ferrero A, Langella S, Sperti E, Capussotti L. Evolution of long-term outcome of liver resection for colorectal metastases: analysis of actual 5-year survival rates over two decades. Ann Surg Oncol. 2012;19:2035–44.

    Article  PubMed  Google Scholar 

  11. Kekelidze M, D’Errico L, Pansini M, Tyndall A, Hohmann J. Colorectal cancer: current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation. World J Gastroenterol. 2013;19:8502–14.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Moulton CA, Gu CS, Law CH, et al. Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases: a randomized clinical trial. JAMA. 2014;311:1863–9.

    Article  CAS  PubMed  Google Scholar 

  13. Ruers TJ, Wiering B, van der Sijp JR, et al. Improved selection of patients for hepatic surgery of colorectal liver metastases with (18)F-FDG PET: a randomized study. J Nucl Med. 2009;50:1036–41.

    Article  PubMed  Google Scholar 

  14. Maffione AM, Lopci E, Bluemel C, Giammarile F, Herrmann K, Rubello D. Diagnostic accuracy and impact on management of (18)F-FDG PET and PET/CT in colorectal liver metastasis: a meta-analysis and systematic review. Eur J Nucl Med Mol Imaging. 2015;42:152–63.

    Article  CAS  PubMed  Google Scholar 

  15. Fletcher JW, Djulbegovic B, Soares HP, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49:480–508.

    Article  PubMed  Google Scholar 

  16. Lopci E, Torzilli G, Poretti D, et al. Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2015;42:1399–407.

    Article  CAS  PubMed  Google Scholar 

  17. Yip VS, Poston GJ, Fenwick SW, Wieshmann H, Athwal T, Malik HZ. FDG-PET-CT is effective in selecting patients with poor long-term survivals for colorectal liver metastases. Eur J Surg Oncol. 2014;40:995–9.

    Article  CAS  PubMed  Google Scholar 

  18. Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27:1386–422.

    Article  PubMed  Google Scholar 

  19. Poston GJ, Tait D, O’Connell S, et al. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ. 2011;343:d6751.

    Article  CAS  PubMed  Google Scholar 

  20. Serrano PE, Gafni A, Gu CS et al. Positron emission tomography-computed tomography (PET-CT) versus no PET-CT in the management of potentially resectable colorectal cancer liver metastases: cost implications of a randomized controlled trial. J Oncol Pract. 2016;12:e765–74.

    Article  PubMed  Google Scholar 

  21. de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250:440–8.

    PubMed  Google Scholar 

  22. Torzilli G, Procopio F, Botea F, et al. One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to the 2-stage approach. Surgery. 2009;146:60–71.

    Article  PubMed  Google Scholar 

  23. Viganò L, Procopio F, Cimino M, et al. Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort. Ann Surg Oncol. 2016;23(4):1352–60.

    Article  PubMed  Google Scholar 

  24. Torzilli G. Ultrasound-Guided Liver Surgery: An Atlas. 1st ed. Springer-Verlag, Milan, 2014.

    Book  Google Scholar 

  25. Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232:777–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer. 2005;104:2658–70.

    Article  PubMed  Google Scholar 

  27. Metser U, You J, McSweeney S, Freeman M, Hendler A. Assessment of tumor recurrence in patients with colorectal cancer and elevated carcinoembryonic antigen level: FDG PET/CT versus contrast-enhanced 64-MDCT of the chest and abdomen. AJR Am J Roentgenol. 2010;194:766–71.

    Article  PubMed  Google Scholar 

  28. Zhang C, Chen Y, Xue H, et al. Diagnostic value of FDG-PET in recurrent colorectal carcinoma: a meta-analysis. Int J Cancer. 2009;124:167–73.

    Article  CAS  PubMed  Google Scholar 

  29. Adam R, de Haas RJ, Wicherts DA, et al. Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol. 2008;26:3672–80.

    Article  PubMed  Google Scholar 

  30. Viganò L, Russolillo N, Ferrero A, et al. Resection of liver metastases from colorectal mucinous adenocarcinoma: is this a different disease? Results of a case-control study. Ann Surg. 2014;260:878–84.

    Article  PubMed  Google Scholar 

  31. Koh JL, Yan TD, Glenn D, Morris DL. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2009;16:327–33.

    Article  PubMed  Google Scholar 

  32. Esquivel J, Chua TC, Stojadinovic A, et al. Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J Surg Oncol. 2010;102:565–70.

    Article  CAS  PubMed  Google Scholar 

  33. Briggs RH, Chowdhury FU, Lodge JPA, Scarbrook AF. Clinical impact of FDG PET-CT in patients with potentially operable metastatic colorectal cancer. Clin Radiol. 2011;66:1167–74.

    Article  CAS  PubMed  Google Scholar 

  34. van Kessel CS, Buckens CF, van den Bosch MA, et al. Preoperative imaging of colorectal liver metastases after neoadjuvant chemotherapy: a meta-analysis. Ann Surg Oncol. 2012;19:2805–13.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Wiering B, Adang EM, van der Sijp JR, et al. Added value of positron emission tomography imaging in the surgical treatment of colorectal liver metastases. Nucl Med Comm. 2010;31:938–44.

    Article  Google Scholar 

Download references

Disclosure

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy

    Luca Viganò MD, PhD, Guido Costa MD & Guido Torzilli MD, PhD, FACS

  2. Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy

    Egesta Lopci MD, Marcello Rodari MD & Arturo Chiti MD

  3. Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy

    Dario Poretti MD, Vittorio Pedicini MD & Luigi Solbiati MD

Authors
  1. Luca Viganò MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Egesta Lopci MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guido Costa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcello Rodari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dario Poretti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vittorio Pedicini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luigi Solbiati MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arturo Chiti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Guido Torzilli MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guido Torzilli MD, PhD, FACS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Viganò, L., Lopci, E., Costa, G. et al. Positron Emission Tomography-Computed Tomography for Patients with Recurrent Colorectal Liver Metastases: Impact on Restaging and Treatment Planning. Ann Surg Oncol 24, 1029–1036 (2017). https://doi.org/10.1245/s10434-016-5644-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5644-y

Keywords

Search

Navigation