Intraoperative laparoscopic ultrasound-guided resection and microwave ablation for colorectal liver metastases

Abstract

BACKGROUND

Colorectal cancer (CRC) frequently metastasizes to the liver, significantly compromising patient survival. While surgical resection improves outcomes for resectable cases, many patients have limited therapeutic options.

AIM

To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases (CRLM).

METHODS

Between June 2018 and June 2020, 300 patients with CRC and liver metastases were admitted to our hospital. They were divided into two groups (150 cases each) based on treatment method: The control group (ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging) and the observation group [contrast-enhanced ultrasound with Sonazoid (S-CEUS)].

RESULTS

The study group demonstrated better efficacy (P < 0.05), fewer adverse events (P < 0.05), and better survival outcomes compared to the control group (1-year: 80% vs 62%; 3-year: 54% vs 33%; 5-year: 32% vs 18%; median survival: 48 months vs 30 months; hazard ratio = 0.63, 95%CI: 0.48-0.83, P < 0.001). Although Karnofsky Performance Status scores improved in both groups, the scores were significantly higher in the observation group (P < 0.05). Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors (P < 0.05).

CONCLUSION

Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM, reducing complications and enhancing survival. Intraoperative S-CEUS was an independent prognostic factor, supporting its clinical value.

Keywords: Laparoscopy; Ultrasound guidance; Surgical resection; Microwave ablation; Colon cancer; Liver metastases

Core Tip: This study demonstrates that intraoperative laparoscopic ultrasound [contrast-enhanced ultrasound with Sonazoid (S-CEUS)]-guided surgical resection and microwave ablation significantly enhances clinical outcomes in colorectal cancer liver metastasis patients compared to preoperative ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging planning. The S-CEUS group exhibited superior oncologic efficacy (higher 5-year survival: 32% vs 18%), fewer adverse events, and improved quality of life (Karnofsky Performance Status scores). Multivariate analysis confirmed intraoperative S-CEUS utilization and primary tumor differentiation as independent prognostic factors. These findings highlight S-CEUS-guided strategies as a critical advance in optimizing oncologic precision and long-term survival in metastatic liver surgery, warranting broader clinical adoption.