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Li C, Liu Y, Xu J, Song J, Wu M, Chen J. Contrast-Enhanced Intraoperative Ultrasonography with Kupffer Phase May Change Treatment Strategy of Metastatic Liver Tumors - A Single-Centre Prospective Study. Ther Clin Risk Manag 2021; 17:789-796. [PMID: 34366666 PMCID: PMC8337051 DOI: 10.2147/tcrm.s317469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022] Open
Abstract
Aim To compare the diagnostic performance of contrast-enhanced intraoperative ultrasonography (CE-IOUS) with Kupffer phase in metastatic liver tumours. Methods Twenty-seven consecutive patients with liver metastasis were prospectively recruited from November 2019 to July 2020 in the Department of HPB, Beijing Hospital. MRI and Contrast Enhanced Ultrasonography (CEUS) were obtained preoperatively, and the diagnosis was made by radiologists independently and blindly. Intraoperative ultrasonography (IOUS) and CE-IOUS with Sonazoid were done by the same sophisticated surgeon and sonographer and Kupffer phase was used to detect lesions. The sensitivity and specificity to detect lesions were compared between different radiologic methods. Then, the changes in treatment strategy due to CE-IOUS with Sonazoid were analysed. Results Twenty-seven patients were included. In MRI, 91 lesions were detected with sensitivity 93.3% (70/75) and specificity 68.8% (11/16). In CEUS, it was 97.1% (68/70) and 86.7% (13/15) in 85 lesions. Meanwhile, in the Kupffer phase in CE-IOUS, 99 lesions were found and 8 new lesions were discovered in 7 cases, with sensitivity 97.5% (80/82) and specificity 94.1% (16/17). The four imaging methods showed no statistic significance in sensitivity and specificity in detecting lesions (Cochran’s Q 10.825, P=0.055). Treatment strategies were altered in 7 patients, 6 achieved R0 resection or ablation, and 1 patient changed from planned R0 resection to palliative surgery. Conclusion CE-IOUS may play a similar or even better role than other radiological methods in diagnosing liver metastasis. The CE-IOUS using Sonazoid demonstrated a high sensitivity and specificity for finding occult metastases intraoperatively and changing the treatment strategy.
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Affiliation(s)
- Chen Li
- Department of Ultrasonography, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yuan Liu
- Department of Ultrasonography, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Jingyong Xu
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Jinghai Song
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Mingxiao Wu
- Department of Ultrasonography, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Jian Chen
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
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Hagopian EJ. Liver ultrasound: A key procedure in the surgeon's toolbox. J Surg Oncol 2020; 122:61-69. [DOI: 10.1002/jso.25908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Ellen J. Hagopian
- Department of General SurgeryHackensack‐Meridian School of Medicine at Seton Hall University New Jersey
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Walker TLJ, Bamford R, Finch-Jones M. Intraoperative ultrasound for the colorectal surgeon: current trends and barriers. ANZ J Surg 2017; 87:671-676. [PMID: 28771975 DOI: 10.1111/ans.14124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/12/2017] [Accepted: 05/28/2017] [Indexed: 12/14/2022]
Abstract
Up to two thirds of patients diagnosed with colorectal cancer (CRC) develop colorectal liver metastases (CRLMs) and one quarter of patients present with synchronous metastases. Early detection of CRLM widens the scope of potential treatment. Surgery for CRLM offers the best chance of a cure. Current preoperative staging of CRC relies on computerized tomography and magnetic resonance imaging. Intraoperative ultrasound (IOUS) scans and contrast-enhanced IOUS (CE-IOUS) have been demonstrated to detect additional metastases not seen on routine preoperative imaging. IOUS is not widely used by colorectal surgeons during primary resection for CRC. Confident use of IOUS/CE-IOUS during primary resection of CRC may improve decision-making by providing the most sensitive form of liver staging even when compared with magnetic resonance imaging. This may be particularly important in the era of laparoscopic resections, where the colorectal surgeon loses the opportunity to palpate the liver. There are several implied barriers to the routine use of IOUS/CE-IOUS by colorectal surgeons. These include time pressure, familiarity with techniques, a perceived learning curve, cost implications and limitation of the modality due to operator variations. Inclusion of IOUS in the training of colorectal surgeons and further investigation of potential benefits of IOUS/CE-IOUS could potentially reduce these barriers, enabling usage during primary resection for CRC to become more widespread.
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Affiliation(s)
- Thomas L J Walker
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, UK
| | - Richard Bamford
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, UK
| | - Margaret Finch-Jones
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, UK
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Ellebæk SB, Fristrup CW, Mortensen MB. Intraoperative Ultrasound as a Screening Modality for the Detection of Liver Metastases during Resection of Primary Colorectal Cancer - A Systematic Review. Ultrasound Int Open 2017; 3:E60-E68. [PMID: 28597000 DOI: 10.1055/s-0043-100503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/15/2016] [Accepted: 12/18/2016] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancer diseases worldwide. One in 4 patients with CRC will have a disseminated disease at the time of diagnosis and often in the form of synchronous liver metastases. Studies suggest that up to 30% of patients have non-recognized hepatic metastases during primary surgery for CRC. Intraoperative ultrasonography examination (IOUS) of the liver to detect liver metastases was considered the gold standard during open CRC surgery. Today laparoscopic surgery is the standard procedure, but laparoscopic ultrasound examination (LUS) is not performed routinely. Aim To perform a systematic review of the test performance of IOUS and LUS regarding the detection of synchronous liver metastases in patients undergoing surgery for primary CRC. Method The literature was systematically reviewed using the search engines: PubMed, Cochrane, Embase and Google. 21 studies were included in the review and the key words: intraoperative ultrasound, laparoscopic ultrasound, staging colon and rectum cancer. Results Intraoperative ultrasound showed a higher sensitivity, specificity, positive predictive value and overall accuracy for the detection liver metastases during surgery for primary CRC, compared to preoperative imaging modalities (ultrasound, computed tomography (CT) and contrast-enhanced computed tomography (CE-CT)). LUS showed a higher detection rate for liver metastases compared to CT, CE-CT and magnetic resonance imaging (MRI). Conclusion This systematic review found that both IOUS and LUS had a higher detection rate regarding liver metastases during primary CRC surgery, especially liver metastases<10 mm in diameter, when compared to US, CT, CE-CT and MRI.
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Modern Technical Approaches in Hepatic Surgery for Colorectal Metastases. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Preoperative detection of hepatic metastases from colorectal cancer: Prospective comparison of contrast-enhanced ultrasound and multidetector-row computed tomography (MDCT). Diagn Interv Imaging 2016; 97:851-5. [PMID: 27132590 DOI: 10.1016/j.diii.2015.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The goal of this study was to prospectively compare the sensitivity of contrast-enhanced ultrasound (CEUS) with that of multiphase multidetector-row computed tomography (MDCT) in the preoperative detection of hepatic metastases. MATERIALS AND METHOD Forty-eight patients, with a mean age of 62years old (range: 43-85years) were prospectively included. All patients underwent CEUS following intravenous administration of 2.4mL of an ultrasound contrast agent (Sonovue(®), Bracco, Milan, Italy) and multiphase MDCT. Intraoperative ultrasound examination (IOUS) was used as the standard of reference. RESULTS A total of 158 liver metastases were identified by IOUS, 127 by preoperative MDCT (sensitivity; 80.4%) and 102 by CEUS (sensitivity, 64.5%). The 15.9% difference in sensitivity between CEUS and MDCT was statistically significant (P=0.002). There was a disagreement between IOUS and CEUS in 23 patients (47%) and in 13 patients (27%) between IOUS and MDCT. MDCT identified one or more additional metastases in 10 patients (20%) resulting in a change in the surgical strategy. CONCLUSION Based on an unselected patient cohort and using multiphase MDCT, CEUS is significantly inferior to MDCT for the preoperative detection of hepatic metastases of colorectal cancer.
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Altuntas YE, Unel S, Gezen FC, Aksakal N, Civil O, Vural S, Ozates M, Oncel M. Stereotactic excision of additional lesions detected with intraoperative ultrasound examination during radiofrequency dissecting sealar (habib®) assisted hepatic metastasectomy: report of 4 cases. Indian J Surg 2014; 76:61-5. [PMID: 24799786 DOI: 10.1007/s12262-012-0554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 06/04/2012] [Indexed: 11/30/2022] Open
Abstract
Intraoperative ultrasound has been using to achieve a proper resection strategy in patients undergoing a hepatic colorectal metastasectomy. This study aims to describe and reveal the place of stereotactic metastasectomy in nonpalpable colorectal liver metastases (CLM). A chart review was initiated for all patients underwent resection for CLM between 2006 and 2011. The data concerning perioperative data and intraoperative strategy were abstracted. Among the 58 patients, who underwent a resection for CLM, 4 (6.9 %) (all men, median age 65.5, range 49-72, years) necessitated a stereotactic metastasectomy. Preoperative evaluations showed 1 (n = 1), 2 (n = 2), or 3 (n = 1) lesions, and intraoperative ultrasound (IUS) found an additional lesion in a case. Stereotactic marking was performed for nonpalpable lesions located in segments IVA, II, and VI and at the junction of segments V and VI. The margins were negative for all lesions both resected with conventional and stereotactic techniques. The examinations of the stereotactic resection materials revealed metastatic adenocarcinoma (patients n = 2), focal nodular hyperplasia (n = 1), and abnormal benign liver histology probably induced by chemotherapy (n = 1). The median (range) operation and hospitalization periods were 217.5 (150-310) minutes and 5.5 (2-9) days. No complications were observed except biliary fistula in a case, which spontaneously disappeared within 2 weeks. A patient died due to systemic disease including hepatic metastases 33 months after the liver surgery. Stereotactic metastasectomy may be feasible for the removal of nonpalpable CLM. Further evaluations are necessitated to understand the accurate place of this novel technique.
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Affiliation(s)
- Yunus E Altuntas
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey ; Altayçeşme Mah. Varna Sok. No:15/B D:2 Menekşe Sit., Maltepe, Istanbul, 34843 Turkey
| | - Sacide Unel
- Radiology Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Fazlı C Gezen
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Nihat Aksakal
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Osman Civil
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Selahattin Vural
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozates
- Radiology Department of Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Oncel
- General Surgery Department of Kartal Education and Research Hospital, Istanbul, Turkey ; Medical College of Gumushane University, Gumushane, Turkey
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Munireddy S, Katz S, Somasundar P, Espat NJ. Thermal tumor ablation therapy for colorectal cancer hepatic metastasis. J Gastrointest Oncol 2012; 3:69-77. [PMID: 22811871 DOI: 10.3978/j.issn.2078-6891.2012.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/13/2012] [Indexed: 12/22/2022] Open
Abstract
Surgical resection for colorectal hepatic metastases (CRHM) is the preferred treatment for suitable candidates, and the only potentially curative modality. However, due to various limitations, the majority of patients with CRHM are not candidates for liver resection. In recent years, there has been an increasing interest in the role of thermal tumor ablation (TTA) as a component of combined resection-ablation strategies, staged hepatic resections, or as standalone adjunct treatment for patients with CRHM. Thus, ablative approaches have expanded the group of patients with CRHM that may benefit from liver-directed treatment strategies.
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Affiliation(s)
- Sanjay Munireddy
- Surgical Oncology, Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, USA
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Schuld J, Kollmar O, Seidel R, Black C, Schilling MK, Richter S. Estimate or calculate? How surgeons rate volumes and surfaces. Langenbecks Arch Surg 2012; 397:763-9. [DOI: 10.1007/s00423-012-0942-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
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Shah AJ, Callaway M, Thomas MG, Finch-Jones MD. Contrast-enhanced intraoperative ultrasound improves detection of liver metastases during surgery for primary colorectal cancer. HPB (Oxford) 2010; 12:181-7. [PMID: 20590885 PMCID: PMC2889270 DOI: 10.1111/j.1477-2574.2009.00141.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Computed tomography (CT) is the most common staging investigation in colorectal cancer (CRC). Up to 25% of patients are found to have previously undetected hepatic lesions when intraoperative ultrasound (IOUS) of the liver is used during CRC resection. We aimed to assess the ability of IOUS to detect additional liver lesions/metastases at primary colorectal resection, and to evaluate whether contrast-enhanced IOUS (CE-IOUS) improves the detection and characterization of hepatic lesions. METHODS We performed a single-centre, prospective pilot study. At CRC resection, patients underwent IOUS of the liver. Contrast-enhanced IOUS of the liver was undertaken using i.v. sulphur hexafluoride micro-bubbles (SonoVue, 4.8 ml). Findings of CT, non-enhanced IOUS and CE-IOUS were compared. Changes in staging or management were noted. Additional lesions were corroborated with iron oxide magnetic resonance imaging (MRI). RESULTS Among 21 patients, IOUS demonstrated additional lesions in seven (33%). Contrast altered the diagnosis of non-enhanced IOUS in four (20%) and changed the management strategy in three (14%) patients. Thus, IOUS in combination with the contrast agent altered the intraoperative or postoperative management plan in four patients. CONCLUSIONS In the first study of its kind, early results suggest that the ability of IOUS to detect additional metastases is improved by CE-IOUS, and that this may impact on surgical staging and management.
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Affiliation(s)
- Ankur J Shah
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal InfirmaryBristol, UK
| | - Mark Callaway
- Department of Radiology, Bristol Royal InfirmaryBristol, UK
| | - Michael G Thomas
- Department of Colorectal Surgery, Bristol Royal InfirmaryBristol, UK
| | - Meg D Finch-Jones
- Department of Hepato-Pancreato-Biliary Surgery, Bristol Royal InfirmaryBristol, UK
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Comparison of CT colonography vs. conventional colonoscopy in mapping the segmental location of colon cancer before surgery. ACTA ACUST UNITED AC 2009; 35:589-95. [PMID: 19763682 DOI: 10.1007/s00261-009-9570-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 08/20/2009] [Indexed: 12/15/2022]
Abstract
Once presence of a colorectal cancer has been diagnosed, a key factor for patient's prognosis in view of surgical intervention is the correct segmental localization and resection of the tumor. The aim of this work was to compare the accuracy of the current gold standard technique, conventional colonoscopy (CC), to computed tomography colonography (CTC) in the segmental localization of tumor. Sixty-five patients (mean age 64; 45 female and 19 male) with colorectal cancer diagnosed at colonoscopy underwent CTC before surgery. In 45 out of 65 cases (69%), patients were referred to CTC after incomplete CC. Reasons were patient intolerance to CC or presence of stenosing cancer, with consistent difficulties in crossing the tract of the colon involved by the lesion. CTC allowed the complete colonic examination in 63/65 cases, since in 2 patients with an obstructing lesion of the sigmoid colon, pneumocolon could not be obtained. However, per patient and per lesion sensitivity of CTC was 100%. Difference from colonoscopy was statistically significant (P < 0.05). In terms of segmental localization of masses, CTC located precisely all lesions, while colonoscopy failed in 16/67 (24%) lesions, though six were missed for incomplete colonoscopy (9%). In the remaining 10/67 (15%) lesions, detected by colonoscopy but incorrectly located, the mismatch occurred in the rectum (n = 3), sigmoid (n = 2), descending (n = 1), transverse (n = 2), ascending colon, and cecum. Agreement between CTC and CC was fair (k value 0.62). Sensitivity, specificity, positive predictive value and negative predictive value of CTC in determining the precise location of colonic masses were respectively 100%, 96%, 85%, and 100%. CT detected hepatic (6/65 patients) and lung metastases (3/65 patients). CT colonography has better performance in the identification of colonic masses (diameter > 3 cm), in the completion of colonic evaluation and in the segmental localization of tumor. CTC should replace colonoscopy for preoperative staging of colorectal cancer.
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Piccolboni D, Ciccone F, Settembre A, Corcione F. Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases. Surg Endosc 2008; 22:1421-6. [DOI: 10.1007/s00464-008-9886-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 01/18/2008] [Accepted: 02/02/2008] [Indexed: 12/17/2022]
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Bhattacharjya S, Aggarwal R, Davidson BR. Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen - a prospective study. Br J Cancer 2006; 95:21-6. [PMID: 16804525 PMCID: PMC2360492 DOI: 10.1038/sj.bjc.6603219] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 04/20/2006] [Accepted: 05/15/2006] [Indexed: 12/11/2022] Open
Abstract
The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18-60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1-21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (P < 0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection.
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Affiliation(s)
- S Bhattacharjya
- Department of Surgery, Royal Free and University College School of Medicine, University College London, The Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - R Aggarwal
- Department of Surgery, Royal Free and University College School of Medicine, University College London, The Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - B R Davidson
- Department of Surgery, Royal Free and University College School of Medicine, University College London, The Royal Free Hospital, Pond Street, London NW3 2QG, UK
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