Clinical decision making utility of contrast-enhanced intraoperative ultrasound (CE-IOUS) during surgery for colorectal liver metastases (CRLM). The Uliis Study NTC 01880554

422 Background: In the era of parenchymal sparing surgery, detecting more colorectal liver metastases (CRLM) is essential to optimize the treatment. We evaluated the added-value of contrast enhanced intraoperative ultrasound (CE-IOUS) with a prospective design. Methods: We used an optimal 2-stage Simon’s design for this two-center study open for patients with operable CRLMs. Primary objective was the justified clinical utility of contrast-enhanced IOUS. Secondary objectives included detection rate of CRLMs, characterization rate of focal liver lesions, specific toxicity and detection of missing CRLMs. Results: Among the 58 eligible patients, 54 were eligible and assessable. Of these 54 patients, 36 were men (66.7%), median age was 63.6 years (range, 37-81), and 43 patients underwent pre-operative chemotherapy. The median number of CRLMs was 2 (range, 1-11). Pre-operative staging was performed using MRI in all 58 eligible patients, CT scan in 41 (70%) and PET-scan in 21 (36%). Compared to pre-operative staging, IOUS allowed identification of 40 new CRLMs in 11 (20.4%) patients. Furthermore, compared to IOUS, CE-IOUS allowed identification of 9 additional CRLMs in 8 (14.8%) patients. The correct detection rate based on pathological exams was 0.94. No additional missing CRLM was diagnosed. The surgical procedure was altered in 5 (9.26%) patients but was justified only in 4 patients (one lesion was ablated without previous biopsy), leading to a clinical utility rate of 7.70% (95 CI, [3.2, 18.6]). There was no specific toxicity reported. Conclusions: Despite the primary endpoint not met for one protocol violation,the Uliis study demonstrates an added-value for CE-IOUS for surgeons treating CRLMs, especially for advanced cases pre-treated by chemotherapy. Clinical trial information: NCT01880554.

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First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-01890-3 ◽

2020 ◽

Vol 405 (3) ◽

pp. 373-379

Author(s):

Carina Riediger ◽

Verena Plodeck ◽

Johannes Fritzmann ◽

Alexander Pape ◽

Alexander Kohler ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Intraoperative Ultrasound ◽

Intraoperative Mri ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Enhanced Mri ◽

Contrast Enhanced ◽

Contrast Enhanced Mri ◽

Staged Hepatectomy

Abstract Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

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The role of contrast-enhanced intraoperative ultrasound (CE-IOUS) in surgery for colorectal liver metastases: a meta-analysis

HPB ◽

10.1016/j.hpb.2021.08.337 ◽

2021 ◽

Vol 23 ◽

pp. S832-S833

Author(s):

M. Fergadi ◽

D. Magouliotis ◽

M. Vlychou ◽

C. Rountas ◽

E. Tatsios ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Meta Analysis ◽

Intraoperative Ultrasound ◽

Contrast Enhanced

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Prognostic and Therapeutic Implications of Tumor Biology in Colorectal Liver Metastases

Cancers ◽

10.3390/cancers14010088 ◽

2021 ◽

Vol 14 (1) ◽

pp. 88

Author(s):

Carsten Kamphues ◽

Katharina Beyer ◽

Georgios Antonios Margonis

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Clinical Decision Making ◽

Tumor Biology ◽

Clinical Decision ◽

Prognostic Models ◽

Treatment Benefit ◽

Colorectal Cancer Liver Metastases ◽

Therapeutic Implications ◽

Prognostic Stratification

Prognostic models allow clinicians to predict survival outcomes, facilitate patient–physician discussions, and identify subgroups with potentially distinct prognoses. Although such prognostic stratification cannot directly predict treatment benefit, it can help to inform clinical decision making. This editorial will discuss potential avenues for these topics in the context of colorectal cancer liver metastases (CRLM)[...]

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