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Chen JY, Dai HY, Li CY, Jin Y, Zhu LL, Zhang TF, Zhang YX, Mai WH. Improved sensitivity and positive predictive value of contrast-enhanced intraoperative ultrasound in colorectal cancer liver metastasis: a systematic review and meta-analysis. J Gastrointest Oncol 2022; 13:221-230. [PMID: 35284117 PMCID: PMC8899757 DOI: 10.21037/jgo-21-881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/07/2022] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Surgery is an effective treatment for improving the survival rate of patients with colorectal cancer liver metastases (CRLM). However, accurately determining the resection margin of liver lesions during surgery remains challenging. Therefore, this study aimed to evaluate the sensitivity and predictive value of intraoperative contrast-enhanced ultrasound (CE-IOUS) in CRLM patients undergoing surgery. METHODS We performed a literature search of the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases using the following search terms: metastatic liver cancer, colorectal cancer, sensitivity, contrast-enhanced intraoperative ultrasound, CE-IOUS, colorectal liver metastases, and CRLM. The search period was set from the date of establishment of the database to September 2021. Quality assessment of diagnostic accuracy studies 2 (QUADAS-2) recommended by the Cochrane Collaboration was used to assess the methodological quality of the included studies, and network meta-analysis was performed using Stata 15.0 software. RESULTS A total of 10 articles met the inclusion criteria. The meta-analysis results showed that the overall sensitivity and specificity of CE-IOUS were 0.96 [95% confidence interval (CI), 0.95-0.97] and 0.75 (95% CI, 0.70-0.80), respectively. The overall sensitivity and specificity of IOUS were 0.84 (95% CI, 0.82-0.86) and 0.82 (95% CI, 0.77-0.87), respectively. The area under the summary receiving operating characteristic (SROC) curves (AUCs) of CE-IOUS and IOUS were 0.9753 and 0.8590, respectively. The odds ratio (OR) and 95% CI of CE-IOUS changed the surgical margin were 0.205 and 0.071-0.465, P=0.000, the difference was statistically significant. DISCUSSION Based on the results of this meta-analysis, CE-IOUS improved the sensitivity and predictive value of CRLM detection compared with IOUS, and is more suitable for intraoperative planning of surgical margins. At present, it is the most sensitive imaging method available, and is recommended for use during liver resection to provide doctors with more reliable information during surgery.
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Affiliation(s)
- Jun-Yao Chen
- Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China
| | - Hui-Yong Dai
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Cai-Yang Li
- Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China
| | - Ying Jin
- Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China
| | - Ling-Ling Zhu
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Tian-Fei Zhang
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Yan-Xia Zhang
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Wen-Hao Mai
- Department of Anorectal Diseases, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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Uz Z, Shen L, Milstein DMJ, van Lienden KP, Swijnenburg RJ, Ince C, van Gulik TM. Intraoperative Imaging Techniques to Visualize Hepatic (Micro)Perfusion: An Overview. Eur Surg Res 2020; 61:2-13. [PMID: 32659780 DOI: 10.1159/000508348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
The microcirculation plays a crucial role in the distribution of perfusion to organs. Studies have shown that microcirculatory dysfunction is an independent predictor of morbidity and mortality. Hence, assessment of liver perfusion offers valuable information on the (patho)physiological state of the liver. The current review explores techniques in perfusion imaging that can be used intraoperatively. Available modalities include dynamic contrast-enhanced ultrasound, handheld vital microscopes, indocyanine green fluorescence angiography, and laser contrast speckle imaging. Dynamic contrast-enhanced ultrasound relays information on deep tissue perfusion and is a commonly used technique to assess tumor perfusion. Handheld vital microscopes provide direct visualization of the sinusoidal architectural structure of the liver, which is a unique feature of this technique. Intraoperative fluorescence imaging uses indocyanine green, a dye that is administered intravenously to visualize microvascular perfusion when excited using near-infrared light. Laser speckle contrast imaging produces non-contact large surface-based tissue perfusion imaging free from movement- or pressure-related artefacts. In this review, we discuss the intrinsic advantages and disadvantages of these techniques and their clinical and/or scientific applications.
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Affiliation(s)
- Zühre Uz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands, .,Department of Translational Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,
| | - Lucinda Shen
- Department of Translational Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Krijn P van Lienden
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Can Ince
- Department of Translational Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Intraoperative Ultrasound Staging for Colorectal Liver Metastases in the Era of Liver-Specific Magnetic Resonance Imaging: Is It Still Worthwhile? JOURNAL OF ONCOLOGY 2019; 2019:1369274. [PMID: 31662749 PMCID: PMC6778901 DOI: 10.1155/2019/1369274] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/24/2019] [Accepted: 08/11/2019] [Indexed: 01/16/2023]
Abstract
Background To assess the efficacy of intraoperative ultrasound (IOUS) compared with liver-specific magnetic resonance imaging (MRI) in patients with colorectal liver metastases (CRLMs). Methods From January 2010 to December 2017, 721 patients underwent MRI as a part of preoperative workup within 1 month before hepatectomy and were considered for the study. Early intrahepatic recurrence (relapse at cut surface excluded) was assessed 6 months after the resection and was considered as residual disease undetected by IOUS and/or MRI. IOUS and MRI performance was compared on a patient-by-patient basis. Long-term results were also studied. Results A total of 2845 CRLMs were detected by MRI, and the median number of CRLMs per patient was 2 (1–31). Preoperative chemotherapy was administered in 489 patients (67.8%). In 177 patients, 379 new nodules were intraoperatively found and resected. Among 379 newly identified nodules, 317 were histologically proven CRLMs (11.1% of entire series). The median size of new CRLMs was 6 ± 2.5 mm. Relationships between intrahepatic vessels and tumors differed between IOUS and MRI in 128 patients (17.7%). The preoperative surgical plan was intraoperatively changed for 171 patients (23.7%). Overall, early intrahepatic recurrence occurred in 8.7% of cases. To assess the diagnostic performance, 24 (3.3%) recurrences at the cut surface were excluded; thus, 5.4% of early relapses were considered for analysis. The sensitivity of IOUS was superior to MRI (94.5% vs 75.1%), while the specificity was similar (95.7% vs 95.9%). Multivariate analysis at the hepatic dome or subglissonian and mucinous histology revealed predictive factors of metastases missing at MRI. The 5-year OS (52.1% vs 37.8%, p=0.006) and DF survival (45.1% vs 33%, p=0.002) were significantly worse among patients with new CRLMs than without. Conclusions IOUS improves staging in patients undergoing resection for CRLMs even in the era of liver-specific MRI. Intraoperative detection of new CRLMs negatively affects oncologic outcomes.
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Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer. J Minim Invasive Gynecol 2018; 25:848-854. [DOI: 10.1016/j.jmig.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/26/2017] [Accepted: 12/28/2017] [Indexed: 11/21/2022]
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Wang W. Diagnostic Value of Ultrasound in Metastatic Liver Cancer. MULTIDISCIPLINARY MANAGEMENT OF LIVER METASTASES IN COLORECTAL CANCER 2017:103-112. [DOI: 10.1007/978-94-017-7755-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Torzilli G, Botea F, Donadon M, Cimino M, Procopio F, Pedicini V, Poretti D, Montorsi M. Criteria for the selective use of contrast-enhanced intra-operative ultrasound during surgery for colorectal liver metastases. HPB (Oxford) 2014; 16:994-1001. [PMID: 24830573 PMCID: PMC4487750 DOI: 10.1111/hpb.12272] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/12/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contrast-enhanced intra-operative ultrasound (CE-IOUS) for colorectal liver metastases (CLMs) has become a part of clinical practice. Whether it should be selectively or routinely applied remains unclear. The aim of this study was to define criteria for the use of CE-IOUS. METHODS One-hundred and twenty-seven patients underwent a hepatectomy for CLMs using IOUS and CE-IOUS. All patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) within 2 weeks prior to surgery. The reference was histology, and imaging at 6 months after surgery. Univariate and multivariate analyses were performed. Statistical significance was set at P = 0.05. RESULTS Using IOUS an additional 172 lesions in 51 patients were found. CE-IOUS found 14 additional lesions in 6 patients. Seventy-eight CLMs in 38 patients appeared within 6 months after surgery. The sensitivity, specificity, positive- and negative-predictive value were 63%, 98%, 100% and 27% for pre-operative imaging, 87%, 100%, 100% and 52% for IOUS, and 89%, 100%, 100% and 56% for IOUS+CE-IOUS, respectively. CE-IOUS allowed better tumour margin definition in 23 patients (18%), thus assisting resection. Analyses indicated that the presence of multiple (P = 0.014), and isoechoic CLMs (P = 0.049) were independently correlated with new findings at CE-IOUS. CONCLUSIONS Compared with IOUS, CE-IOUS improved detection and resection guidance. These additions are significant and demand its use in cases with multiple and isoechoic CLMs.
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Affiliation(s)
- Guido Torzilli
- Department of Hepatobiliary Surgery, University of Milan, Humanitas Research HospitalMilan, Italy,Correspondence, Guido Torzilli, Department of Hepatobiliary Surgery, University of Milan, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy. Tel: 39 02 8224 4502. Fax: 39 02 8224 4590. E-mail: ;
| | - Florin Botea
- Department of Hepatobiliary Surgery, University of Milan, Humanitas Research HospitalMilan, Italy
| | - Matteo Donadon
- Department of Hepatobiliary Surgery, University of Milan, Humanitas Research HospitalMilan, Italy
| | - Matteo Cimino
- Department of Hepatobiliary Surgery, University of Milan, Humanitas Research HospitalMilan, Italy
| | - Fabio Procopio
- Department of Hepatobiliary Surgery, University of Milan, Humanitas Research HospitalMilan, Italy
| | - Vittorio Pedicini
- Department of Radiology, University of Milan, Humanitas Research HospitalMilan, Italy
| | - Dario Poretti
- Department of Radiology, University of Milan, Humanitas Research HospitalMilan, Italy
| | - Marco Montorsi
- Department of General Surgery, University of Milan, Humanitas Research HospitalMilan, Italy
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Viganò L, Capussotti L, Lapointe R, Barroso E, Hubert C, Giuliante F, Ijzermans JNM, Mirza DF, Elias D, Adam R. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients. Ann Surg Oncol 2014; 21:1276-1286. [PMID: 24346766 DOI: 10.1245/s10434-013-3421-8] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE The aims of this study were to assess the risk of early recurrence after liver resection for colorectal metastases (CRLM) and its prognostic value; identify early recurrence predictive factors; clarify the effect of perioperative chemotherapy on its occurrence; and elucidate the best early recurrence management. METHODS Patients of the LiverMetSurvey registry who underwent complete liver resection (R0/R1) between 1998 and 2009 were reviewed. Early recurrence was defined as any recurrence that occurred within 6 months after resection. RESULTS A total of 6,025 patients were included; 2,734 (45.4 %) had recurrence, including 639 (10.6 %) early recurrences. Early recurrence was mainly hepatic (59.5 vs. 54.4 % for late recurrences; p = 0.023). Independent risk factors of early recurrence were: T3-4 primary tumor (p = 0.0002); synchronous CRLM (p = 0.0001); >3 CRLM (p < 0.0001); 0-mm margin liver resection (p = 0.003); and associated intraoperative radiofrequency ablation (p = 0.0005). Response to preoperative chemotherapy (complete/partial) and administration of adjuvant chemotherapy reduced early recurrence risk (p = 0.003 and p < 0.0001, respectively). Intraoperative ultrasonography reduced hepatic early recurrence rate (p = 0.025). Early recurrence negatively affected prognosis: 5-year survival 26.9 versus 49.4 % for the late recurrence group (p < 0.0001, median follow-up 34.4 months). Overall, 234 (36.6 %) patients with early recurrence underwent re-resection. These patients had survival rates higher than non-re-resected patients (5-year survival 47.2 vs. 8.9 %; p < 0.0001) and similar to re-resected patients for late recurrence (48.7 %). Chemotherapy before early recurrence resection improved later survival (5-year survival 61.5 vs. 43.7 %; p = 0.028). CONCLUSIONS Early recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment, but is reduced after adjuvant chemotherapy. Although early recurrence negatively affects prognosis, re-resection may restore better survival. Chemotherapy before early recurrence resection is advocated.
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Affiliation(s)
- Luca Viganò
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy,
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Ferrero A, Langella S, Giuliante F, Viganò L, Vellone M, Zimmitti G, Ardito F, Nuzzo G, Capussotti L. Intraoperative liver ultrasound still affects surgical strategy for patients with colorectal metastases in the modern era. World J Surg 2013; 37:2655-2663. [PMID: 23974959 DOI: 10.1007/s00268-013-2183-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The present study was designed to evaluate the role of intraoperative ultrasound (IOUS) in intrahepatic staging and the impact on surgical strategy for patients with colorectal liver metastases (CRLM). METHODS The study included 515 patients who had undergone liver resection for CRLM at two tertiary care referral centers. Data from a prospectively collected database were retrospectively analysed. Early intrahepatic recurrence was assessed at 3 and 6 months after resection and was considered as residual disease undetected by IOUS. Performance of imaging modalities was compared by analysis of studies on individual patients. RESULTS A total of 1,370 liver metastases were detected preoperatively with a median of 3 imaging modalities. MRI and PET were performed in 51 and 42 % of the patients, respectively. Median number of days between last imaging and surgery was 18. Contrast-enhanced IOUS was performed in 136 patients (26.4 %). Intraoperatively, 293 new nodules were found in 132 patients: on histology 280 were CRLM (17.6 %). Surgical strategy was changed in 140 patients (27.2 %). On multivariate analysis synchronous and bilobar metastases ≥ 3 in number, BMI ≥ 30, and time between last imaging and surgery longer than 18 days resulted in predictive factors indicating new nodules detected by IOUS. Early intrahepatic recurrences were 3.7 and 7.9 % at 3 and 6 months. Performance of CT, MRI, FDG-PET, and intraoperative staging was compared: sensitivity was 63.6, 68.8, 53.6, and 92 % and specificity was 91, 92.3, 95.8, and 97.8 %, respectively CONCLUSIONS The use of IOUS continues to be mandatory for correct staging of patients with CRLM undergoing liver resection.
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Affiliation(s)
- Alessandro Ferrero
- Department of Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy,
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Donadon M, Procopio F, Torzilli G. Tailoring the area of hepatic resection using inflow and outflow modulation. World J Gastroenterol 2013; 19:1049-55. [PMID: 23466864 PMCID: PMC3581992 DOI: 10.3748/wjg.v19.i7.1049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 12/07/2012] [Accepted: 12/15/2012] [Indexed: 02/06/2023] Open
Abstract
The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure. The key factor of modern hepatic surgery is the use of the intraoperative ultrasound (IOUS), not only to stage the disease, but more importantly to guide resection with the specific aim to maximize the sparing of the functional parenchyma. Whether in patients with hepatocellular carcinoma and underlying liver cirrhosis, or in patients with colorectal liver metastasis, IOUS allows the performance of the so-called “radical but conservative surgery”, which is the pivotal factor to offer a chance of cure to an increasing proportion of patients, who until few years ago were considered only for palliative care. Using some new IOUS-guided surgical maneuvers, which are based on the liver inflow and outflow modulations, more precise anatomically subsegmental- and segmental-oriented resections can be effectively performed. The present work describes the rationale and the surgical technique for a precise tailoring of the area of hepatic resection using the most recent attainments in IOUS. Such important technical achievements should be a fundamental part of the surgical armamentarium of the modern liver surgeon.
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Ruzzenente A, Conci S, Iacono C, Valdegamberi A, Campagnaro T, Bertuzzo F, Bagante F, De Angelis M, Guglielmi A. Usefulness of contrast-enhanced intraoperative ultrasonography (CE-IOUS) in patients with colorectal liver metastases after preoperative chemotherapy. J Gastrointest Surg 2013; 17:281-287. [PMID: 23065500 DOI: 10.1007/s11605-012-2043-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/26/2012] [Indexed: 01/31/2023]
Abstract
AIMS The aim of this study was to evaluate the ability of contrast-enhanced intraoperative ultrasonography to detect colorectal liver metastases after preoperative chemotherapy compared with intraoperative ultrasound and preoperative imaging techniques. METHODS From January 2010 to December 2011, 28 patients with colorectal liver metastases underwent intraoperative ultrasonography and contrast-enhanced intraoperative ultrasonography during hepatectomy following preoperative chemotherapy. The findings were compared to preoperative imaging using contrast-enhanced ultrasonography, computed tomography, magnetic resonance imaging, and/or fluorodeoxyglucose positron emission tomography. RESULTS Preoperative imaging techniques detected 58 metastatic lesions in 28 patients. In 32 % of patients (n = 9), intraoperative ultrasound detected 24 missed hepatic nodules. In 14 % of patients (n = 4), contrast-enhanced intraoperative ultrasonography detected an additional six nodules and change in operative management occurred in 18 % of patients. Using univariate analysis, we found three factors significantly related to detection of additional metastases with contrast-enhanced intraoperative ultrasonography: three or more metastases before chemotherapy (p = 0.047), resolution of at least one metastasis (p = 0.011), and small liver metastases (largest lesion size ≤20 mm) after chemotherapy (p = 0.007). CONCLUSION In patients undergoing surgery for colorectal liver metastases after chemotherapy, contrast-enhanced intraoperative ultrasonography improved both the sensitivity of intraoperative ultrasonography to detect liver metastases and the R0 hepatic resection rate.
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Affiliation(s)
- Andrea Ruzzenente
- Department of Surgery, Division of General Surgery A, GB Rossi Hospital, University of Verona Medical School, Piazzale LA Scuro 10, 37134, Verona, Italy.
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Takahashi M, Hasegawa K, Arita J, Hata S, Aoki T, Sakamoto Y, Sugawara Y, Kokudo N. Contrast-enhanced intraoperative ultrasonography using perfluorobutane microbubbles for the enumeration of colorectal liver metastases. Br J Surg 2012; 99:1271-7. [PMID: 22829436 DOI: 10.1002/bjs.8844] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intraoperative ultrasonography (IOUS) is considered the standard for the identification of liver metastases. Use of lipid-stabilized perfluorobutane microbubbles as an ultrasound contrast agent may improve this. The value of contrast-enhanced IOUS (CE-IOUS) in enumerating colorectal liver metastases was studied here. METHODS CE-IOUS was performed in consecutive resections for colorectal liver metastases in 2007-2010. All patients underwent preoperative computed tomography. Magnetic resonance imaging was not carried out routinely. Conventional intraoperative examination including IOUS, and CE-IOUS with peripherally injected contrast were performed. The histopathological findings and 6-month follow-up images were used as the reference standard. RESULTS The study group of 102 patients had a total of 315 lesions identified on preoperative imaging (2·4 lesions per operation; 129 operations). Conventional intraoperative examination including IOUS identified 350 lesions (2·7 per operation). CE-IOUS identified 370 lesions (2·9 per operation). The sensitivity, specificity and accuracy of CE-IOUS were 97·1, 59·1 and 93·2 per cent respectively. The CE-IOUS findings altered the surgical plan in 19 operations (14·7 per cent). CONCLUSION CE-IOUS provided additional information to that obtained using contemporary preoperative imaging and conventional intraoperative examinations.
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Affiliation(s)
- M Takahashi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Simpson AL, Dumpuri P, Jarnagin WR, Miga MI. Model-Assisted Image-Guided Liver Surgery Using Sparse Intraoperative Data. STUDIES IN MECHANOBIOLOGY, TISSUE ENGINEERING AND BIOMATERIALS 2012. [DOI: 10.1007/8415_2012_117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Advances in the surgical treatment of colorectal cancer liver metastases through ultrasound. Surg Today 2011; 41:1184-9. [PMID: 21874412 DOI: 10.1007/s00595-010-4527-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 10/05/2010] [Indexed: 01/12/2023]
Abstract
Surgery remains the gold standard of treatment for colorectal cancer liver metastases (CLM). The only limitation of surgery for CLM is its technical feasibility, the key point being to leave enough remnant liver to ensure patient survival. This report describes a surgical procedure based extensively on ultrasound guidance, which allows for curative resection in one stage and also for multiple bilobar CLM. This strategy minimizes the need for two-stage hepatectomy and may thus overcome many of the limitations and consequences of a two-stage approach, such as the impossibility to complete the treatment approach in 20%-25% of patients and the amputation of major vascular structures, which can result in less technical solutions for CLM relapse.
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A new systematic small for size resection for liver tumors invading the middle hepatic vein at its caval confluence: mini-mesohepatectomy. Ann Surg 2010; 251:33-9. [PMID: 19858707 DOI: 10.1097/sla.0b013e3181b61db9] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We describe a new ultrasound guided conservative procedure for patients with liver tumors invading the middle hepatic vein (MHV) at its caval confluence. SUMMARY BACKGROUND DATA Morbidity and mortality for major hepatectomies are not negligible. However, when tumors invade the MHV at the caval confluence, major surgery is usually recommended. METHODS Patients included in this study were those with tumors invading the MHV at its hepato-caval confluence (within 4 cm). Minimum follow-up was established at 6-months from surgery. Among 284 consecutive hepatectomies, 17 (6%) met the inclusion criteria. Partial sparing of segments 4, 5, and 8 was established intraoperatively, based on color-Doppler IOUS findings (NCT00600522 on ClinicalTrials.gov). RESULTS In all the 17 patients at least one of the color-Doppler IOUS criteria was disclosed, and limited resections of just segments 4sup and 8 were always feasible. The MHV tract involved was always resected. Seven patients had single tumor removed and 10 multiple: total number of resected tumors was 58 (median: 2; range: 1-18). There were no postoperative mortality and major morbidity. Overall morbidity occurred in 3 (18%) patients. Median blood loss was 250 (range: 50-1000). One patient (6%) received blood transfusion. No local recurrences were observed (median follow-up: 26 months). CONCLUSIONS IOUS assistance systematically allows conservative resection of liver tumor invading the MHV at caval confluence. This drastically limits the need for larger resections, and further broadens the role of IOUS in optimizing the surgical strategy.
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Torzilli G, Procopio F, Botea F, Marconi M, Del Fabbro D, Donadon M, Palmisano A, Spinelli A, Montorsi M. 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. [DOI: 10.1016/j.surg.2009.02.017] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 02/13/2009] [Indexed: 12/21/2022]
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Ladam-Marcus V, Mac G, Job L, Piot-Veron S, Marcus C, Hoeffel C. [Contrast-enhanced ultrasound and liver imaging: review of the literature]. ACTA ACUST UNITED AC 2009; 90:93-106; quiz 107-8. [PMID: 19212278 DOI: 10.1016/s0221-0363(09)70087-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The advent of second-generation microbubble ultrasound contrast agents and the development of contrast specific ultrasound techniques improved the ability of contrast enhanced ultrasound (CEUS) in detecting and characterizing focal liver lesions, opening new prospects in liver imaging. A Medline search in June 2008 identified 72 published studies that used CEUS in focal liver lesion detection, characterization, and follow-up to monitor tumor ablation procedures and antiangiogenic treatment. The purpose of this paper, based on literature review, is to describe the technical recommendations when using CEUS for liver imaging and to define the different vascular patterns of the most relevant benign and malignant lesions. Diagnostic performance of CEUS and the important clinical indications are also presented and discussed. CEUS is increasingly accepted in clinical use for diagnostic imaging and post-interventional workup liver imaging. It may replace many computed tomography and magnetic resonance imaging examinations in the near future, according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines.
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Affiliation(s)
- V Ladam-Marcus
- CHU de Reims, Hôpital Robert Debré, Pôle d'Imagerie, Service de Radiologie, 51092 Reims Cedex, France.
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