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Background and Aim:
Hepatic resection is the only treatment offering a chance of long-term survival for patients with colorectal liver metastases (CRLM). Preoperative chemotherapy improves survival and resectability but reduces accuracy of preoperative staging due to reduction of size or disappearing of the metastases. Intraoperative Ultrasonography (IOUS) is considered the standard method of intraoperative staging. Contrast-enhanced intraoperative ultrasonography (CE-IOUS), using second generation contrast agents, seems to improve detection of liver metastases after preoperative chemotherapy.
The aim of this study is to evaluate the ability of CE-IOUS in detecting metastases in patients with CRLM during hepatectomy after preoperative chemotherapy and clarify which patients can take advantage from use of CE-IOUS.
Methods:
From January 2011 to August 2011 25 patients with CRLM, after preoperative chemotherapy, underwent IOUS and CE-IOUS during hepatectomy. These findings were compared with preoperative staging imaging, performed with contrast-enhanced ultrasonography (CE-US), CT and/or MRI.
Results:
Preoperative staging imaging detected a total of 40 metastatic lesions in 25 patients. In 7 patients (28%), IOUS detected 19 missed hepatic nodules for a total of 59 lesions (detection rate higher of 47.5% than preoperative imaging). In 9 patients (36%), CE-IOUS detected further 6 nodules for a total of 65 hepatic lesions detected (detection rate higher of 10.2% than preoperative imaging and IOUS). All these new detected lesions were removed by an additional resection and histopathologically diagnosed as metastases. Moreover, at univariate analysis we found three factors significantly correlated to dectection of new nodules with CE-IOUS: more than three metastasis before chemotherapy (p=0.022), complete response to chemotherapy (p=0.03) and size of nodules less than 20 mm after chemotherapy (p=0.008).
Conclusion:
In patients who undergo surgery for CRLM, CE-IOUS improves the sensitivity of IOUS to detect liver metastases enhancing the rate of treatment with curative intent. Patients with multiple nodules, patients who achieve complete response or with nodule size less than 20 mm after chemotherapy can take advantage with use of CE-IOUS.