Potential Value of Contrast-Enhanced Intraoperative Ultrasonography During Partial Hepatectomy for Metastases

Leen, Edward; Ceccotti, Piercarlo; Moug, Susan; Glen, Paul M.; MacQuarrie, John; Angerson, Wilson J.; Albrecht, Thomas; Hohmann, Joachim; Oldenburg, A.; Ritz, JP; Horgan, Paul G.

doi:10.1097/01.sla.0000197708.77063.07

Cited by 179 publications

(132 citation statements)

References 15 publications

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“…It provided information not obtainable with conventional intra-operative ultrasound and modified the course of surgery in 79% of patients undergoing resection for hepatocellular carcinoma [7]. In the detection of liver metastases, it attained 96.1% sensitivity vs. 81.5% with plain ultrasound [8].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Piccolboni

Ciccone

Settembre

et al. 2010

Journal of Ultrasound

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KEYWORDSLiver surgery; Pancreas surgery; Laparoscopic ultrasound.Abstract Introduction: Laparoscopic inspection before pancreatic and liver surgery is a widely accepted approach and has changed the surgical strategy in a growing number of patients for the last 10 years. The addition of intra-operative ultrasound to laparoscopy has further refined surgical judgments. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing hepatic or pancreatic resection for benign or malignant lesions. Materials and methods: In the years 2005e2008, 45 patients (aged 42e75 years) were selected for liver resection, and 48 others (aged 14e72 years) were selected for partial pancreatic resection. Intra-operative ultrasound was performed for surgical staging. An Aloka SSD-5500 scanner (Aloka, Tokyo, Japan) was used with a flexible laparoscopic multifrequency linear and an electronic T-shaped linear probe. Results: LIOUS prevented useless laparotomies in six patients (13.3%) with liver tumors and, coupled with IOUS, revealed previously undetected tumors that required a change in the surgical strategy in 5 others (11.1%). In patients with pancreatic disease, LIOUS excluded the possibility of radical surgery in 7 patients (14.4%) due to the presence of mesenteric vein infiltration, involvement of the celiac or para-aortic nodes, or the presence of liver or peritoneal micro-metastases. In 11 patients with benign lesions, it defined the lesions' relation to the Wirsung duct and splenic vessels, and in 6 others it provided guidance for aspiration of fluid for chemical and cytologic analysis. Conclusions: LIUOS and IOUS can play fundamental roles in selecting patients for resective surgery and in planning the surgical approach. They provided information that affected surgical strategies in 11 patients with liver disease (24.4%) and 13 with pancreas disease (27%).Sommario Introduzione: L'ispezione laparoscopica in chirurgia del pancreas o del fegato è un approccio ampiamente utilizzato. L'aggiunta dell'ecografia intra-operatoria alla laparoscopia ha di recente ulteriormente migliorato la valutazione chirurgica. Lo scopo di questo studio è stato di valutare l'impatto dell'ecografia intra-operatoria open (IOUS) o laparoscopica (LIOUS) in chirurgia del fegato e del pancreas. pancreas. L'ecografia intra-operatoria è stata effettuata per mezzo di un apparecchio Aloka SSD-550 (Aloka, Tokyo, Giappone), con sonda lineare laparoscopica a punta flessibile e sonda elettronica lineare a T. Risultati: Tra i pazienti epatici, la LIOUS ha evitato inutili laparotomie in sei pazienti (13,3%) ed, insieme alla IOUS, ha consentito di trovare noduli non diagnosticati ed ha cambiato la strategia chirurgica in cinque pazienti (11,1%). Nel gruppo pancreas, la LIOUS ha escluso 7 pazienti (14,4%) dalla chirurgia radicale, per infiltrazione della vena mesenterica, coinvolgimento dei linfonodi celici o para-aortici, micro-metastasi epatiche e peritoneali. In 11 lesioni benigne, ha consentito la definizion...

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Section: Discussionmentioning

confidence: 99%

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Piccolboni

Ciccone

Settembre

et al. 2010

Journal of Ultrasound

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“…US is indicated for intraoperative assessment of resectability [18]. When used intraoperatively, CEUS has been shown to reveal more lesions than conventional US [18], and was significantly more sensitive (p Ͻ .05) than CT and/or MRI and conventional US in detecting liver metastases [19].…”

Section: Role Of Imaging In the Diagnosis Of Liver Metastasesmentioning

confidence: 99%

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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ABSTRACTpatients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrastenhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.

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“…While CE is not licensed in some countries, its impact has been demonstrated (diagnosis in 90% with modification of patient management in 17.5 and 15.6%, and up to 30% with CE-IUS) (17,19,20), as well as its implementation cost-effectiveness.…”

Section: Addendummentioning

confidence: 99%

“…It has been shown in 60 patients that CE is more sensitive that intraoperative US (IUS) for the detection of liver metastases, and modifies the management and resection with curative intent in 30% of patients (17).…”

Section: Fact and Future Of Ius And Ce-lapusmentioning

confidence: 99%

Ultrasonographic contrast agents versus sonoelastography in digestive diseases

Varas-Lorenzo¹,

Muñoz-Agel²,

Cugat-Andorrà³

et al. 2011

Rev. esp. enferm. dig.

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A review is made of the indications of ultrasonographic contrast enhancement as applied to conventional ultrasonography and endocopic ultrasonography (EUS) as opposed to the use of EUS-sonoelastography today.Key words: Ultrasonographic contrast media. Contrast-enhanced echoendoscopy. Elastography. Endoscopic sonoelastography. Echoendoscopy with sonoelastography. Neuroendocrine tumors. Pancreatic cancer. Chronic pancreatitis. INTRODUCTIONGastrointestinal real-time, gray-scale ultrasonography (US) has reached high resolution, performance, and sensitivity in the study of biliary, hepatosplenic, pancreatic, and even gastrointestinal (GI) tract conditions. It was then supplemented by color Doppler (CD) and power Doppler or color angiosonography, and more recently by contrast-enhancement (CE) (Gómez, 2007) and three dimensions (3-D) (Muñoz, 2007) in our country (1).The same thing happened to echoendoscopy or endoscopic ultrasonography (EUS). Color, sonoelastography, and contrast media have provided US with a new diagnostic and most particularly therapeutic dimension (2).Color has made it possible to better study blood vessels (portal hypertension and growths).Sonoelastography and contrast agents have attempted to improve diagnosis and avoid histological studies using fine needle aspiration puncture (FNA) (virtual biopsy) ( Figs. 1 and 2).However, what is the future of CE as applied to ultrasonography (CE-US) or endoscopic ultrasonography (CE-EUS), including intraoperative ultrasonography (CE-IUS)?The use of CE in these three diagnostic scenarios -US, EUS, IUS-is discussed below. FACT AND FUTURE OF CE-USThe following indications are now a fact: -Characterization, delimitation, and detection in the liver of hepatic masses in over 90% of patients (3-5); detection of masses in the spleen and pancreas (6). -Diagnosis of portal hypertension and portal thrombosis (100%), even if malignant (94%). -Differentiation between benign and malignant lesions in a percentage above 95% (7). -Study of GI tract microcirculation: thrombosis, ischemia (8), and inflammatory bowel disease (IBD) (9). -Ablative therapy control. The future likely lies in these last two fields: -Gene therapy -Functional studies. FACT AND FUTURE OF CE-EUSThere are no conclusive studies regarding the use of CE-EUS for adenopathies and the GI tract. Vol. 103. N.°4, pp. 204-208, 2011 Received: 28-11-10. Ultrasonographic contrast agents versus sonoelastography in digestive diseases

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Potential Value of Contrast-Enhanced Intraoperative Ultrasonography During Partial Hepatectomy for Metastases

Abstract: These preliminary results suggest CE-IOUS is an essential tool prior to liver resection for metastases.

Cited by 179 publications

References 15 publications

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

Ultrasonographic contrast agents versus sonoelastography in digestive diseases

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