Does CTAP prior to hepatic resection improve patient survival rates?

Abstract

The purpose of our study was to compare survival rates of colon carcinoma patients who had undergone attempted curative hepatic resection based on liver staging by computed tomographic angiography (CTA) or portography (CTAP) with previously reported survival rates of patients who underwent similar surgery without preoperative CTAP evaluations. A total of 404 CTAP studies performed at three institutions were reviewed. Of this group, 197 had colon carcinoma. Sixty-nine of the colon patients went to surgery. Actuarial adjusted yearly survival rates were calculated for the prior CTAP colon group and compared to historical controls. The control survival data were taken from reports published prior to the CTAP era. Our study demonstrated no difference in the 1-year survival data between the groups. However, the CTAP patients had greater survival in years 2-4. This greater survival may be multifactorial but in part due to better surgical selection caused by CTAP.

Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US

“…Computed tomography during arterial portography is considered a very sensitive technique for preoperative diagnostic work-up of liver lesions [4,5,30,31]. Most malignant liver lesions present with increased arterial perfusion and enhance later than liver parenchyma.…”

Malignant liver lesions: Comparison of spiral CT arterial portography and MR imaging for diagnostic accuracy, cost, and effect on patient management

“…Methods to compensate for perfusion defects on CTAP images have been suggested, and include a separate dynamic intravenous contrast-enhanced CT study, delayed image acquisition on CTAP studies, and selective hepatic arterial injection (35)(36)(37). The problem with the first two approaches is that lesion detection is not optimal, and lack of demonstration of a lesion in an area of a perfusion defect on CTAP by these methods does not exclude the presence of a lesion (7). To illustrate this point, all 26 patients in our study were considered to have limited malignant disease on the basis of dynamic contrast-enhanced CT performed at other institutions, as an inclusion criterion for this study.…”

Methodological assessment of combined spiral CT angiography and CT arterial portography

“…Such rates of detection exceed any other imaging method, with the exception of intraoperative ultrasound. Some researchers have proposed that CTAP should be required for work up before resection of liver tumors [18][19][20]. Likewise, although CTA is a very sensitive methodology to detect liver tumors, only a few articles have described its utility and pitfalls until now [10][11][12]21].…”