Detailed liver-specific imaging prior to pre-operative chemotherapy for colorectal liver metastases reduces intra-hepatic recurrence and the need for a repeat hepatectomy

Abstract

Background: Neoadjuvant chemotherapy for colorectal liver metastases (CRLM) reduces the accuracy of liver imaging which may understage patients pre‐operatively. Retrospective review of a prospective database to determine whether liver‐specific magnetic resonance imaging (MRI) prior to pre‐operative chemotherapy affects intra‐hepatic recurrence and long‐term outcome after hepatectomy. Patients and methods: Between 2003 and 2009, 242 patients with CRLM underwent a hepatectomy after ≥3 cycles of oxaliplatin or irinotecan‐based chemotherapy. All had a liver‐specific MRI immediately pre‐operatively. The outcome of patients who had a liver‐specific MRI prior to chemotherapy (PCI group, n= 92) was compared with those who did not (non‐PCI group, n= 150). Results: A liver‐specific MRI pre‐chemotherapy changed the staging in 56% of patients. At a median (range) follow‐up of 55 (6–94) months, there was a higher incidence of intra‐hepatic recurrence at a new site in the non‐PCI group (65% vs. 48% in the PCI group, P= 0.041) and an increased rate of recurrence in patients with the same number of lesions pre‐ and post‐chemotherapy [hazard ratio (HR) 2.02, 1:10–3.37, P= 0.024]. The non‐PCI group underwent more repeat hepatectomies than the PCI group (24.7% vs. 13%, P= 0.034), achieving similar long‐term survival. Conclusions: A liver‐specific MRI prior to chemotherapy reduces intra‐hepatic recurrence and avoids a repeat hepatectomy.

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

“…Furthermore, while CT was performed routinely in all patients prior to chemoradiotherapy and liver surgery, liver-specific MRI was only performed in 64.4% of the patients in this time period. A liver-specific MRI prior to preoperative chemotherapy for colorectal liver metastases has been shown to improve staging and reduce the need for a repeat hepatectomy [33]. Compared to CT, MRI may have a higher sensitivity for detecting small and uncertain lesions and has routinely been used in all patients evaluated for colorectal liver metastases in the authors' institution during the last 2 years [34].…”

Vascular Supply to the Liver: A Report of a Rare Arterial Variant

“…Preoperative knowledge of variant arterial anatomy has the potential to reduce operative morbidity and mortality by providing an intraoperative roadmap [10–13]. It is also required to plan endovascular therapies such as transarterial embolization for hepatic malignancies [15–17]. This is further supported by the fact that variations to the classic arterial supply to the liver are present in 37% of unselected persons in the Caribbean population [8].…”

Navigated three-dimensional T1-weighted gradient-echo sequence for gadoxetic acid liver magnetic resonance imaging in patients with limited breath-holding capacity

“…The role of HBP images for the detection of FLLs in hepatocytespecific contrast-enhanced liver MRI has recently been demonstrated in several studies, and is widely regarded as a valuable tool for the evaluation of primary and secondary liver malignancies [32,33]. However, acquisition of high-quality HBP imaging is not always possible in clinical practice, and radiologists quite frequently encounter aged patients with liver cirrhosis and HCCs or CRLM patients who have lower physical abilities and limited breath-holding capacities.…”