Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands,
J Gastrointest Surg. 2013 Oct;17(10):1836-49. doi: 10.1007/s11605-013-2185-6. Epub 2013 Apr 25.
A systematic preoperative evaluation to determine the individual resection strategy in patients with colorectal liver metastases (CRLM) was assessed as to its clinical value.
From 2009 to 2011, 75 patients with CRLM who were scheduled for surgery were prospectively included and received an additional preoperative systematic evaluation in the presence of a hepatobiliary radiologist and the hepatobiliary surgeon scheduled to perform the surgery. The following items were assessed in a standardized manner: lesion detection and characterization, presence of extrahepatic disease, vascular anatomy, and resection strategy. Intraoperative findings and histopathological results were prospectively recorded.
Five out of 75 patients were not considered to be eligible for surgery due to additional findings, such as additional metastases or extrahepatic disease. Sensitivity and specificity for detection of individual CRLM were 80.9% (95% CI 75.7-86.1%) and 69.1% (95% CI 59.1-79.1%), respectively. Radical resections were performed in 87.1%. There was one futile laparotomy (1.4%).
In patients with colorectal liver metastases, standardized preoperative work-up, with subsequent planning of an individualized resection in a jointed meeting of a hepatobiliary radiologist and the surgeon who will perform the operation, leads to a high level of radical resections and a low number of futile laparotomies.
对结直肠癌肝转移（CRLM）患者进行系统的术前评估以确定个体化的切除策略，评估其临床价值。
2009 年至 2011 年，前瞻性纳入 75 例计划接受手术的 CRLM 患者，并在肝胆放射科医生和计划进行手术的肝胆外科医生的参与下，进行额外的术前系统评估。以标准化的方式评估以下项目：病变的检测和特征、是否存在肝外疾病、血管解剖结构和切除策略。术中发现和组织病理学结果均进行前瞻性记录。
由于额外发现，如其他转移灶或肝外疾病，5 例患者被认为不符合手术条件。单独 CRLM 的检测灵敏度和特异性分别为 80.9%（95%CI 75.7-86.1%）和 69.1%（95%CI 59.1-79.1%）。87.1%的患者接受了根治性切除术。1 例患者行无效剖腹手术（1.4%）。
在结直肠癌肝转移患者中，通过标准化的术前评估，并随后由肝胆放射科医生和将要进行手术的外科医生共同制定个体化的切除计划，可实现高水平的根治性切除和低比例的无效剖腹手术。
