Usefulness of Contrast-Enhanced Intraoperative Ultrasonography (CE-IOUS) in Patients with Colorectal Liver Metastases after Preoperative Chemotherapy

Ruzzenente, Andrea; Conci, Simone; Iacono, Calogero; Valdegamberi, Alessandro; Campagnaro, Tommaso; Bertuzzo, Francesca; Bagante, Fabio; Angelis, M. De; Guglielmi, Alfredo

doi:10.1007/s11605-012-2043-y

Cited by 39 publications

(32 citation statements)

References 30 publications

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“…for PET-CT has been suggested for detecting distant metastases [28,29]. Contrast-enhanced intraoperative ultrasound has been shown to improve both the sensitivity of intraoperative ultrasonography to detect LM and the rate of complete resection of hepatic metastases in patients undergoing surgery for CRCLM after chemotherapy [30].…”

Section: The Role Of Imaging In the Detection Of Synchronous Crclmmentioning

confidence: 99%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

487

413

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a b s t r a c tAn international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected 612 months and >12 months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, Contents lists available at ScienceDirectCancer Treatment Reviews j o u r n a l h o m e p a g e : w w w . e l s e v i e r h e a l t h . c o m / j o u r n a l s / c t r v and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

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Section: The Role Of Imaging In the Detection Of Synchronous Crclmmentioning

confidence: 99%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

487

413

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“…For the preoperative detection of CRLM after neoadjuvant chemotherapy and consecutive diffuse fatty infiltration of the liver, Kulemann et al found MRI to be superior to MDCT, especially for the detection of small lesions with sensitivities of 65% for CT vs 88% for MRI and for CRLM ≤ 10 mm of 11% for CT vs 66% for MRI [113]. CE-IOUS performed in patients treated with neoadjuvant chemotherapy improves sensitivity and R0 hepatic resection rate [114]. In case of disappearing CRLM (no longer detectable by preoperative imaging = complete clinical response) CE-IOUS might detect even small tumor residuals which is crucial to ensure true R0 resection [115].…”

Section: Ce-ious -Where Are We Today? Essential Tool or Problem Solvementioning

confidence: 99%

“…Summarized, CE-IOUS is still of high value and might be the most effective or even mandatory after preoperative chemotherapy for CRLM [47,114,119].…”

Section: Ce-ious -Where Are We Today? Essential Tool or Problem Solvementioning

confidence: 99%

Impact of Contrast-Enhanced Intraoperative Ultrasound on Operation Strategy in Case of Colorectal Liver Metastasis

et al. 2012

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Background Surgical treatment is the only option for long-term survival in patients with colorectal liver metastasis (CRLM). Contrast-enhanced CT and MRI are usually used for preoperative liver imaging. The initial surgical strategy for liver resection is based upon these findings. Further optimization of the surgical strategy by contrast-enhanced intraoperative ultrasound (CE-IOUS) might further improve the surgical outcome. Purpose To evaluate the current impact of CE-IOUS with SonoVue® on the initial surgical strategy for CRLM. Material and Methods Eighty-six consecutive patients undergoing open liver resection for CRLM were evaluated retrospectively over a 2.5-year period. The patients underwent 97 operations. Preoperative staging was performed with contrast-enhanced CT in all patients and MRI was available in 66 of 86 patients. CE-IOUS was performed in all patients according to a standardized examination technique. Curved array and linear transducers were used. CRLM were identified in venous phase as hypovascular lesions. CE-IOUS findings were compared with preoperative staging. Results Combined CT/MRI identified preoperatively 328 CRLM (mean 3.4, range 0-14). Seventy-two additional lesions (18%) were identified in 38 patients during the operation. Intraoperatively 41 additional CRLM in 20 patients were identified by inspection, palpation, and CE-IOUS (10%), and another 31 CRLM in 17 patients were identified by CE-IOUS alone (8%). All additional CRLM detected by CE-IOUS were confirmed by histology if resection was performed. CE-IOUS changed planned operation strategy in 29.9% of operations. A larger resection was necessary in 13.4% of the cases, reduced liver resection was found sufficient in 11.3%, and 5.2% were found inoperable. For patients diagnosed preoperatively with solitary lesions CE-IOUS changed operation strategy in 19% and radical tumor resection would have failed in 4.8% without CE-IOUS. Conclusion CE-IOUS is essential to ensure optimal and complete tumor resection both in patient with solitary CRLM and multiple metastases.

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“…Intraoperative US has emerged as a valuable additional US technique and has been shown to have a higher sensitivity and specificity than preoperative transabdominal US, especially when combined with contrast-enhanced intraoperative US (13). Intraoperative US has been shown to help detect new metastases in 33%-42% of cases, with the addition of contrast-enhanced intraoperative US helping detect "disappearing" liver metastases after chemotherapy (14). Some of the limitations of US include operator dependence; ambiguity in segmental localization, which is crucial for surgical planning; and poor performance in the presence of hepatic steatosis and diffuse and chronic hepatic disease.…”

Section: Imaging Of Metastases In Crc Ultrasonographymentioning

confidence: 99%

Update on the Role of Imaging in Management of Metastatic Colorectal Cancer

Tirumani¹,

Kim²,

Nishino³

et al. 2014

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Usefulness of Contrast-Enhanced Intraoperative Ultrasonography (CE-IOUS) in Patients with Colorectal Liver Metastases after Preoperative Chemotherapy

Abstract: In patients undergoing surgery for colorectal liver metastases after chemotherapy, contrast-enhanced intraoperative ultrasonography improved both the sensitivity of intraoperative ultrasonography to detect liver metastases and the R0 hepatic resection rate.

Cited by 39 publications

References 30 publications

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Impact of Contrast-Enhanced Intraoperative Ultrasound on Operation Strategy in Case of Colorectal Liver Metastasis

Update on the Role of Imaging in Management of Metastatic Colorectal Cancer

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