Intraoperative Contrast‐Enhanced Ultrasound in Colorectal Liver Metastasis Surgery Improves the Identification and Characterization of Nodules

Abstract

The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.

Outcomes of Resectability Assessment of the Dutch Colorectal Cancer Group Liver Metastases Expert Panel

“…[27][28][29] Furthermore, intraoperative adjustment of the surgical plan is a well-known phenomenon because intraoperative ultrasonography is still known to be the gold standard in revealing the total extent of disease. [30][31][32] We did not note much resistance from local MDTs or surgeons regarding the proposed treatment plans by the panel. Two patients with potentially resectable CRLM, as assessed by the panel, did not finish further panel evaluations because the local surgeon or MDT decided to proceed with surgical resection.…”

Intraoperative contrast-enhanced ultrasound has an outcome-relevant impact on surgery of primary and metastatic liver lesions

“…Although several studies have shown the ability of CE-IOUS to detect lesions unknown preoperatively [13,14], the resulting implications for the surgical approach during liver surgery have usually only been a secondary endpoint. For example, Torzilli et al [9] and Arita et al [15] described a CE-IOUS-related change in strategy for CRLM patients in 18 % and 10 % of cases, respectively.…”

Liver ultrasound: A key procedure in the surgeon's toolbox

“…The sensitivity of both enhanced and nonenhanced ultrasound was better than either liver‐specific contrast‐enhanced MRI (82% sensitivity) or CT (81% sensitivity) 5 . The use of CEUS in the operating room can also be particularly useful in managing patients undergoing liver resection with disappearing liver metastases, 23‐25 and can not only find, but also characterize new lesions found during primary colorectal cancer resection 26 . CEUS also has been shown to differentiate small dysplastic nodules from hepatocellular carcinomas in liver cirrhosis 27 .…”