3D image guidance assisted identification of colorectal cancer liver metastases not seen on intraoperative ultrasound: results from a prospective trial.

BACKGROUND Neoadjuvant treatment of colorectal liver metastases has become increasingly common, and while effective, often renders small metastases difficult to visualize on intraoperative US. The objective of this study was to determine the utility of a 3D image-guidance system in patients with intraoperative sonographically-occult CRLM. METHODS 50 patients with at least one CRLM ≤ 1.5 cm were enrolled in this prospective trial of an FDA-approved Explorer image-guidance system. If the tumor(s) seen on preoperative imaging were not identified with intraoperative US, Explorer was used to target the US examination to the involved area for a more focused assessment. The primary endpoint was the proportion of cases with sonographically-occult metastases identified using Explorer. RESULTS Forty-eight patients with preoperative scans within eight weeks of surgery were included for analysis. Forty-six patients were treated with preoperative chemotherapy (median 4 months, range 2-24 months). Overall, 22 sonographically-occult tumors in 14 patients were interrogated by Explorer, of which 15 tumors in 10 patients were located with image-guidance assistance. The only difference between patients with tumors not identified on US and those who did was the number of tumors (median 3 vs. 2, p = 0.018). CONCLUSION 3D image-guidance can assist in identifying small CRLM, particularly after treatment with chemotherapy. TRIAL REGISTRATION ClinicalTrials.gov, NCT02806037, https://clinicaltrials.gov/ct2/show/NCT02806037.

[1]  Emad M Boctor,et al.  The effect of steatosis on echogenicity of colorectal liver metastases on intraoperative ultrasonography. , 2010, Archives of surgery.

[2]  A. Saiura,et al.  Routine Preoperative Liver-specific Magnetic Resonance Imaging Does Not Exclude the Necessity of Contrast-enhanced Intraoperative Ultrasound in Hepatic Resection for Colorectal Liver Metastasis , 2015, Annals of surgery.

[3]  Sharif Razzaque,et al.  Laparoscopic microwave ablation of human liver tumours using a novel three-dimensional magnetic guidance system. , 2015, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[4]  Stefan Weber,et al.  Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases. , 2014, World journal of gastroenterology.

[5]  Ming-de Lu,et al.  Focal Lesions in Fatty Liver: If Quantitative Analysis Facilitates the Differentiation of Atypical Benign from Malignant Lesions , 2016, Scientific Reports.

[6]  Logan W. Clements,et al.  Concepts and Preliminary Data Toward the Realization of Image-guided Liver Surgery , 2007, Journal of Gastrointestinal Surgery.

[7]  Logan W. Clements,et al.  Evolution of Image-Guided Liver Surgery: Transition from Open to Laparoscopic Procedures , 2013, Journal of Gastrointestinal Surgery.

[8]  Logan W. Clements,et al.  Image-guided liver surgery: intraoperative projection of computed tomography images utilizing tracked ultrasound. , 2012, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[9]  Logan W. Clements,et al.  Robust surface registration using salient anatomical features for image-guided liver surgery: algorithm and validation. , 2008, Medical physics.

[10]  L H Blumgart,et al.  Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. , 1999, Annals of surgery.

[11]  M. Galia,et al.  Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound , 2004, European Radiology.

[12]  K. Lee,et al.  Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound , 2010, European Radiology.

[13]  Catherine Julié,et al.  Complete response of colorectal liver metastases after chemotherapy: does it mean cure? , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  O. Catalano,et al.  Real-time harmonic contrast material-specific US of focal liver lesions. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[15]  Jung Wook Seo,et al.  Planning ultrasound for percutaneous radiofrequency ablation to treat small (≤ 3 cm) hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging: a multicenter prospective study to assess factors affecting ultrasound visibility. , 2012, Journal of vascular and interventional radiology : JVIR.

[16]  Logan W. Clements,et al.  Evaluation of a Minimally Invasive Image-Guided Surgery System for Hepatic Ablation Procedures , 2014, Surgical innovation.

[17]  Michael A. Choti,et al.  Surgical Therapy for Colorectal Metastases to the Liver , 2007, Journal of Gastrointestinal Surgery.

[18]  T. Ravikumar,et al.  Resection of hepatic metastases from colorectal cancer. Biologic perspective. , 1989, Annals of surgery.

[19]  T. Baère,et al.  Coil-Assisted RFA of Poorly Visible Liver Tumors: Effectiveness and Risk Factors of Local Tumor Progression , 2013, CardioVascular and Interventional Radiology.

[20]  Samuel Achilefu,et al.  Intraoperative detection of liver tumors aided by a fluorescence goggle system and multimodal imaging. , 2013, The Analyst.

[21]  S. Nahum Goldberg,et al.  Real-Time US-CT/MRI Image Fusion for Guidance of Thermal Ablation of Liver Tumors Undetectable with US: Results in 295 Cases , 2015, CardioVascular and Interventional Radiology.

[22]  G. Widmann,et al.  Navigated open, laparoscopic, and percutaneous liver surgery. , 2011, Minerva chirurgica.

[23]  Bernard Paule,et al.  Rescue Surgery for Unresectable Colorectal Liver Metastases Downstaged by Chemotherapy: A Model to Predict Long-term Survival , 2004, Annals of surgery.