The routine use of intra‐operative ultrasound in patients with colorectal cancer improves the detection of hepatic metastases

Agrawal, Nikhil; Fowler, A. L.; Thomas, Michael G.

doi:10.1111/j.1463-1318.2005.00916.x

Cited by 21 publications

(23 citation statements)

References 17 publications

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“…The ability to detect occult disease is limited by the technical resolution of currently available imaging equipment. Intra-operative ultrasound is the most sensitive technique and all these patients had had an intra-operative ultrasound at the time of first liver resection (Machi et al, 1987;Agrawal et al, 2006). As none of these patients proved to be amenable to further liver resection they will represent a poor prognosis group in whom surveillance is less likely to be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18 -60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1 -21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (Po0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection.

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Section: Discussionmentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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“…Visual estimation of tissue quantity and size is also necessary in the intraoperative choice of stapling devices [10] or vascular grafts with resulting functional complications in cases of a non-fitting device [11]. Intraoperative imaging techniques, such as sonography in hepatic surgery, may be helpful in localising anatomical structures [12]. They cannot, however, predict remaining organ volume or resection surface area.…”

Section: Introductionmentioning

confidence: 99%

Estimate or calculate? How surgeons rate volumes and surfaces

Schuld

Kollmar

Seidel

et al. 2012

Langenbecks Arch Surg

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We found a large bias in estimating the dimension of both commonly used objects and the surface area of liver parenchyma transection. Obviously, estimating errors are more influenced by the individual subject who estimates than by the object itself. In clinical routine, surgeons should rely more on simple measuring devices than on their own sense of proportion. Education in how to estimate more correctly human liver resection surfaces can be achieved by ex vivo studies using porcine livers.

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“…The superiority of the IOUS compared to pre-operative studies in terms of sensibility leads to a modification of the surgical strategy [32]. The main limitation of the IOUS is the difficult characterization of the nodules; it has been ridden out after the introduction of the USCAs.…”

Section: Colorectal Liver Metastasesmentioning

confidence: 99%

The Role of Ultrasound in Hepatic Surgery

Garancini¹,

Gianotti²,

Romano³

et al. 2013

Hepatic Surgery

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The routine use of intra‐operative ultrasound in patients with colorectal cancer improves the detection of hepatic metastases

Abstract: IOUS increases diagnostic yield but a significant proportion of patients with occult hepatic metastases are not detected. IOUS improves disease staging in some patients refining the indications for adjuvant therapy and enhancing the estimate of prognosis and improving decision-making.

Cited by 21 publications

References 17 publications

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Estimate or calculate? How surgeons rate volumes and surfaces

The Role of Ultrasound in Hepatic Surgery

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