Langella Serena, Ardito Francesco, Russolillo Nadia, Panettieri Elena, Perotti Serena, Mele Caterina, Giuliante Felice, Ferrero Alessandro
Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Torino, Italy.
Unit of Hepatobiliary Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy.
J Oncol. 2019 Sep 22;2019:1369274. doi: 10.1155/2019/1369274. eCollection 2019.
To assess the efficacy of intraoperative ultrasound (IOUS) compared with liver-specific magnetic resonance imaging (MRI) in patients with colorectal liver metastases (CRLMs).
From January 2010 to December 2017, 721 patients underwent MRI as a part of preoperative workup within 1 month before hepatectomy and were considered for the study. Early intrahepatic recurrence (relapse at cut surface excluded) was assessed 6 months after the resection and was considered as residual disease undetected by IOUS and/or MRI. IOUS and MRI performance was compared on a patient-by-patient basis. Long-term results were also studied.
A total of 2845 CRLMs were detected by MRI, and the median number of CRLMs per patient was 2 (1-31). Preoperative chemotherapy was administered in 489 patients (67.8%). In 177 patients, 379 new nodules were intraoperatively found and resected. Among 379 newly identified nodules, 317 were histologically proven CRLMs (11.1% of entire series). The median size of new CRLMs was 6 ± 2.5 mm. Relationships between intrahepatic vessels and tumors differed between IOUS and MRI in 128 patients (17.7%). The preoperative surgical plan was intraoperatively changed for 171 patients (23.7%). Overall, early intrahepatic recurrence occurred in 8.7% of cases. To assess the diagnostic performance, 24 (3.3%) recurrences at the cut surface were excluded; thus, 5.4% of early relapses were considered for analysis. The sensitivity of IOUS was superior to MRI (94.5% vs 75.1%), while the specificity was similar (95.7% vs 95.9%). Multivariate analysis at the hepatic dome or subglissonian and mucinous histology revealed predictive factors of metastases missing at MRI. The 5-year OS (52.1% vs 37.8%, =0.006) and DF survival (45.1% vs 33%, =0.002) were significantly worse among patients with new CRLMs than without.
IOUS improves staging in patients undergoing resection for CRLMs even in the era of liver-specific MRI. Intraoperative detection of new CRLMs negatively affects oncologic outcomes.
评估术中超声（IOUS）与肝脏特异性磁共振成像（MRI）在结直肠癌肝转移（CRLMs）患者中的疗效。
2010年1月至2017年12月，721例患者在肝切除术前1个月内接受MRI作为术前检查的一部分，并纳入本研究。术后6个月评估早期肝内复发（不包括切缘复发），并将其视为IOUS和/或MRI未检测到的残留疾病。对每位患者的IOUS和MRI表现进行比较。还研究了长期结果。
MRI共检测到2845个CRLMs，每位患者CRLMs的中位数为2个（1 - 31个）。489例患者（67.8%）接受了术前化疗。177例患者术中发现并切除了379个新结节。在379个新发现的结节中，317个经组织学证实为CRLMs（占整个系列的11.1%）。新CRLMs的中位大小为6±2.5毫米。128例患者（17.7%）的IOUS和MRI显示肝内血管与肿瘤之间的关系不同。171例患者（23.7%）术中改变了术前手术计划。总体而言，8.7%的病例发生了早期肝内复发。为评估诊断性能，排除了24例（3.3%）切缘复发；因此，5.4%的早期复发纳入分析。IOUS的敏感性优于MRI（94.5%对75.1%），而特异性相似（95.7%对95.9%）。对肝穹窿或肝门部及黏液性组织学进行多因素分析，揭示了MRI遗漏转移灶的预测因素。有新CRLMs的患者5年总生存率（52.1%对37.8%，P = 0.006）和无病生存率（45.1%对33%，P = 0.002）明显低于无新CRLMs的患者。
即使在肝脏特异性MRI时代，IOUS也能改善CRLMs切除患者的分期。术中检测到新的CRLMs对肿瘤学结局有负面影响。
