Intraoperative ultrasonographic detection of occult liver metastases in colorectal cancer

Abstract

The efficacy of intraoperative ultrasonographic detection of colorectal cancer liver metastases was evaluated in 85 patients undergoing operation for primary colorectal tumors or liver secondaries. The results of intraoperative ultrasonography were compared with those of preoperative ultrasonography and computed tomography, as well as the intraoperative appearances of the liver. Additional information about the number of metastases was obtained in 12 cases (14.1%); 17 (24.3%) out of 70 metastases could only be detected by intraoperative ultrasonography. In 4 cases (4.7%) these lesions were solitary. As a result, the operative procedure of choice was changed in 15.3% of the patients. We conclude that intraoperative ultrasonography has a significantly higher ability to detect colorectal cancer liver metastases than preoperative methods or intraoperative inspection and palpation. Intraoperative ultrasonography should be performed in patients without preoperative evidence of liver metastases and in all patients with planned resection of metastases.

Resection of colorectal liver metastases

“…There is a general agreement that a margin of 1 cm or more is preferable [19,23,63], and there is a growing consensus that this judgment must not be based on palpation of the liver, but should be guided by routine application of operative ultrasonography [27,64]. From our practice, a preference for anatomic procedures, such as segmentectomies, according to COUINAUD's terminology instead of non-anatomic wedge excisions is advisable since these procedures are more likely to achieve satisfactory margins and reduce the incidence of inadvertently non-radical procedures [44].…”

“…Besides clinical evaluation of the abdominal cavity including inspection and palpation of the liver, the most important method is operative ultrasonography [53, 83,84]. In roughly 5-15%, this alters the surgical approach [64]. Additional metastases may preclude resection, or the interrelation between tumor edge and important intrahepatic vascular structures may change the resection strategy.…”

Chirurgische therapie von lebermetastasen therapieverfahren, ergebnisse und prognosefaktoren

“…Dennoch ist eine Prognoseverbesserung bei technisch im Gesunden durchgeftihrter Resektion nicht nur wahrscheinlich, doch durch die Anzahl der 5-Jahres-Uberlebenden auch gesichert [2,3,27,43]. des Metastasierungsstadiums sowohl bei der Prim~iroperation als auch bei der Operation von Lebermetastasen [11,48]. In unserer Studie war die Radi-kalit~t des Lebereingriffs der st~rkste prognostische Faktor, kein Patient mit palliativer Resektion erreichte eine Oberlebenszeit von mehr als 3 Jahren.…”

Intraoperative and laparoscopic sonography of the liver

“…4) [19][20][21][22][23][24][25]. Several studies have demonstrated the superiority of intraoperative sonography over noninvasive preoperative imaging modalities for detecting hepatic metastases [21][22][23][26][27][28]. Intraoperative sonography has been shown to depict between 20 and 30 % more hepatic tumours than preoperative sonography and CT [21][22][23].…”