Oldhafer Karl J, Stavrou Gregor A, Prause Guido, Peitgen Heinz-Otto, Lueth Tim C, Weber Stefan
Department of General and Visceral Surgery, Celle General Hospital, Siemensplatz 4, 29223, Celle, Germany.
Langenbecks Arch Surg. 2009 May;394(3):489-94. doi: 10.1007/s00423-009-0469-9. Epub 2009 Mar 12.
As recent chemotherapy regimens for metastatic colorectal cancer become more and more effective in a neoadjuvant setting before liver surgery, a "complete" clinical response is sometimes documented on imaging. Without operation though, metastatic recurrence is likely to commence within 12 months. Surgeons now face the problem to resect non-visualizable and non-palpable lesions.
Computer-based virtual surgery planning can be used to fuse pre- and postchemotherapy computed tomography data to develop an operative strategy. This information is then intraoperatively transferred to the liver surface using an image-guided stereotactically navigated ultrasound dissector. This enables the surgeon to perform a resection that is otherwise not possible.
During operation, detection of the lesion through palpation or ultrasound was impossible. After registering the virtual operation plan into the navigation system, the planned resection was performed without problems. Histopathologic workup showed vital tumor cells in the specimen.
The new image-guided stereotactic navigation technique combined with virtual surgery planning can solve the surgeon's dilemma and yield a successful operation.
随着近期用于转移性结直肠癌的化疗方案在肝脏手术前的新辅助治疗中越来越有效，影像学上有时会记录到“完全”的临床反应。然而，如果不进行手术，转移性复发很可能在12个月内开始。外科医生现在面临着切除不可见和不可触及病变的问题。
基于计算机的虚拟手术规划可用于融合化疗前后的计算机断层扫描数据，以制定手术策略。然后使用图像引导的立体定向导航超声解剖器将该信息术中转移至肝脏表面。这使外科医生能够进行原本无法进行的切除。
手术过程中，通过触诊或超声无法检测到病变。将虚拟手术计划注册到导航系统后，按计划进行切除没有问题。组织病理学检查显示标本中有存活的肿瘤细胞。
新的图像引导立体定向导航技术与虚拟手术规划相结合，可以解决外科医生的困境并实现成功手术。
