One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: A feasible and effective alternative to the 2-stage approach

Torzilli, Guido; Procopio, Fabio; Botea, Florin; Marconi, Matteo; Fabbro, Daniele Del; Donadon, Matteo; Palmisano, Angela; Spinelli, Antonino; Montorsi, Marco

doi:10.1016/j.surg.2009.02.017

Cited by 154 publications

(93 citation statements)

References 34 publications

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“…Based on this concept, even more PSHs for CRLMs were performed in recent years. [24][25][26] This change of 9 who demonstrated that, in case of single CRLM of 3 cm, the parenchymal-sparing technique improved survival in case of liver recurrence, allowing for salvage re-hepatectomy as compared to a NON-PSH approach. To our knowledge, there was no report in the literature establishing a comparison between NON-PSH and PSH for multiple bilobar resections for more than 3 lesions which analyzed shortterm and long-term results.…”

Section: Discussionmentioning

confidence: 99%

Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: A propensity score matching analysis

Méméo

Association

2018

European Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: A propensity score matching analysis

Méméo

Association

2018

European Journal of Surgical Oncology

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“…Increasing the use of ablation from 0% [4] to 100% (present study) results in a reduction in the use of PVE from 100% [4] to 10% and a reduction in mortality. It has also been reported that CARe diminishes the use of two-stage procedures [20] and even overall costs [26]. Limitations of this study include missing data due to the retrospective analysis and the disparities inherent to practices of different surgeons.…”

Section: Discussionmentioning

confidence: 90%

“…Non-anatomical resection was long considered to be a transgression of the orthodox liver surgery based on vascular rules inherited from transplant surgery [18]. It was later accepted [19] and lastly brought to its peak by Torzilli et al [20] most notably to allow iterative procedures. Ablation is a pragmatic non-anatomical concept, with a high propensity to spare healthy parenchyma.…”

Section: Discussionmentioning

confidence: 99%

64. Combined Ablation and Resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases

Désolneux

Évrard

Poston³

et al. 2014

European Journal of Surgical Oncology (EJSO)

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“…It has been shown that conventional ultrasonography is particularly useful when applied intra-operatively for imaging liver metastases and has been utilised with great success for many years [30][31][32][33]. Propagation of ultrasonic waves is not hindered to any significant degree during liver metastasis surgery because laparotomy is performed prior to data capture.…”

Section: Discussionmentioning

confidence: 99%

Visualisation of liver tumours using hand-held real-time strain imaging: results of animal experiments

Melodelima

Chenot²,

Souchon³

et al. 2012

BJR

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Objective: Surgical resection is the only curative option for colorectal hepatic metastases. Intra-operative localisation of these metastases during hepatic resection is performed by intra-operative B-mode imaging and palpation. Because liver metastases are stiffer than normal tissues, elastography may be a useful complement to B-mode imaging. This paper reports quantitative measures of the image quality attained during intra-operative real-time elastographic visualisation of liver metastasis. Methods: VX2 tumours were implanted in the liver of eight rabbits and were scanned in vivo. Measurements of the tumour dimensions obtained via elastography were compared with those obtained using B-mode imaging and with gross pathology. Results: Measurements of tumour diameters were similar when obtained by intraoperative elastography and pathological measurement methods (mean difference ¡ standard deviation, 0.1¡0.9 mm). The contrast between tumours and normal tissues was significantly higher (p,0.05) in elastograms (26¡10 dB contrast) than in sonograms (1¡1 dB contrast). Sensitivity and specificity for detecting tumours using intra-operative elastography were 100% and 88%, respectively, and positive and negative predictive values were 89% and 100%, respectively. In two cases elastograms were able to detect a tumour that was ambiguous in B-mode images. Conclusion: Combined hand-held B-mode/strain imaging may provide additional information that is relevant for detection of liver metastases that may be missed by standard B-mode imaging alone, such as small and/or isoechoic tumours. Colorectal cancer is the fourth most common cancer in males and the third most common cancer in females worldwide [1,2]. Approximately half of these patients either present with hepatic metastases or develop them during the course of their disease. Although ablative therapies are frequently used, resection of liver metastases, when possible, remains the preferred therapy for potential cure [3,4]. The overall 5 year survival rates are in the range of 35-58% in several studies reporting on the results of hepatectomy conducted with curative intent [4,5]. The pre-operative and intra-operative staging of metastases is essential to remove all metastases and increase the rate of cure. At the pre-operative stage, contrast-enhanced CT is the most commonly used modality to screen for metastases. It is highly sensitive, particularly since the introduction of helical CT and multidetector systems capable of scanning the entire liver in a few seconds, allowing for several scans during the liver's different circulatory phases [6]. MRI is very sensitive as well, and has the advantage of liver-specific contrast if required. MRI is also used for screening purposes, despite the fact that it is more time-consuming than other methodologies and may be subject to motion artefacts [7]. According to different reports, these modalities detect .90% of liver metastases if their diameter is .5 mm [7,8]. There is still a group of patients who undergo hepatic surgery without c...

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One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: A feasible and effective alternative to the 2-stage approach

Cited by 154 publications

References 34 publications

Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: A propensity score matching analysis

Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: A propensity score matching analysis

64. Combined Ablation and Resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases

Visualisation of liver tumours using hand-held real-time strain imaging: results of animal experiments

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