Clinical implications of disappearing colorectal liver metastases have changed in the era of hepatocyte-specific MRI and contrast-enhanced intraoperative ultrasonography.

Abstract

BACKGROUND:

Clinical implication of disappearing liver metastases (DLMs) from colorectal cancer after chemotherapy needs to be reviewed in the era of modern imaging studies.

METHODS:

Between 2010 and 2015, 184 patients underwent curative hepatectomy for colorectal liver metastases following preoperative chemotherapy. The sites of metastases detected on pre-chemotherapy CE-CT were examined post-chemotherapy using CE-CT, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), and contrast-enhanced intraoperative ultrasonography (CE-IOUS). DLMs were defined as tumors that disappeared on CE-CT post chemotherapy. The detection rate of DLMs with EOB-MRI and CE-IOUS were assessed, and the outcome of DLMs resected and those left in place were reviewed.

RESULTS:

A total of 275 DLMs were noted in 59 patients. On EOB-MRI, 71 lesions (26%) were visible and were resected, 92% (65/71) of which contained viable disease. Using CE-IOUS, an additional 94 lesions were identified. A total of 165 DLMs (60%) were identified and resected by sequential use of EOB-MRI and CE-IOUS, 77% (127/165) of which contained viable disease. Of 110 DLMs not identified, 68 were resected, 4% (3/68) of which contained viable disease. Among 42 lesions left in place, 6 (14%) recurred during the median follow-up period of 27 (9-72) months.

DISCUSSION:

EOB-MRI and CE-IOUS exploration identified clinically relevant DLMs containing viable disease with a high level of accuracy.

• Authors: Atsushi Oba, Yoshihiro Mise, Hiromichi Ito, Makiko Hiratsuka, Yosuke Inoue, Takeaki Ishizawa, Junichi Arita, Kiyoshi Matsueda, Yu Takahashi, Akio Saiura
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 20 Issue 8 Pg. 708-714 (08 2018) ISSN: 1477-2574 [Electronic] England
• PMID: 29534862 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Contrast Media
• Fluorocarbons
• gadolinium ethoxybenzyl DTPA
• Gadolinium DTPA
• perfluorobutane

Topics

• Adult
• Aged
• Aged, 80 and over
• Cell Survival
• Chemotherapy, Adjuvant
• Clinical Decision-Making
• Colorectal Neoplasms (pathology)
• Contrast Media (administration & dosage)
• Female
• Fluorocarbons (administration & dosage)
• Gadolinium DTPA (administration & dosage)
• Hepatectomy (adverse effects)
• Humans
• Intraoperative Care
• Liver Neoplasms (diagnostic imaging, secondary, therapy)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neoadjuvant Therapy (adverse effects)
• Predictive Value of Tests
• Reproducibility of Results
• Treatment Outcome
• Ultrasonography (methods)