Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
Section of Abdominal Imaging, Cleveland Clinic, Cleveland, OH, USA.
Surg Endosc. 2022 Jul;36(7):4939-4945. doi: 10.1007/s00464-021-08849-5. Epub 2021 Nov 3.
The aim of this study was to assess the utility of laparoscopic ultrasound (LUS) during minimally invasive liver procedures in patients with malignant liver tumors who underwent preoperative magnetic resonance imaging (MRI).
Medical records of patients with malignant liver lesions who underwent laparoscopic liver surgery between October 2005 and January 2018 and who underwent an MRI examination at our institution within a month before surgery were collected from a prospectively maintained database. The size and location of tumors detected on LUS, as well as whether they were seen on preoperative imaging, were recorded. Univariate and multivariate regression analyses were performed to identify factors that were associated with the detection of liver lesions on LUS that were not seen on preoperative MRI.
A total of 467 lesions were identified in 147 patients. Tumor types included colorectal cancer metastasis (n = 53), hepatocellular cancer (n = 38), neuroendocrine metastasis (n = 23), and others (n = 33). Procedures included ablation (67%), resection (23%), combined resection and ablation (6%), and diagnostic laparoscopy with biopsy (4%). LUS identified 39 additional lesions (8.4%) that were not seen on preoperative MRI in 14 patients (10%). These were colorectal cancer (n = 20, 51%), neuroendocrine (n = 11, 28%) and other metastases (n = 8, 21%). These additional findings on LUS changed the treatment plan in 13 patients (8.8%). Factors predicting tumor detection on LUS but not on MRI included obesity (p = 0.02), previous exposure to chemotherapy (p < 0.001), and lesion size < 1 cm (p < 0.001).
This study demonstrates that, despite advances in MRI, LUS performed during minimally invasive liver procedures may detect additional tumors in 10% of patients with liver malignancies, with the highest yield seen in obese patients with previous exposure to chemotherapy. These results support the routine use of LUS by hepatic surgeons.
本研究旨在评估腹腔镜超声（LUS）在接受术前磁共振成像（MRI）检查的恶性肝肿瘤患者微创肝手术中的应用价值。
从一个前瞻性维护的数据库中收集了 2005 年 10 月至 2018 年 1 月期间在我院接受腹腔镜肝手术且术前一个月内接受 MRI 检查的恶性肝病变患者的病历。记录 LUS 检测到的肿瘤的大小和位置，以及术前影像学是否可见。进行单变量和多变量回归分析，以确定与术前 MRI 未见的肝病变在 LUS 上检测到相关的因素。
共在 147 例患者的 467 个病灶中发现肿瘤类型包括结直肠癌转移（n=53）、肝细胞癌（n=38）、神经内分泌转移（n=23）和其他（n=33）。手术包括消融术（67%）、切除术（23%）、联合切除和消融术（6%）以及诊断性腹腔镜活检（4%）。LUS 在 14 例患者（10%）中发现了 39 个术前 MRI 未见的额外病灶（8.4%）。这些病灶包括结直肠癌（n=20，51%）、神经内分泌（n=11，28%）和其他转移（n=8，21%）。LUS 的这些额外发现改变了 13 例患者（8.8%）的治疗计划。预测 LUS 而非 MRI 上肿瘤检测的因素包括肥胖（p=0.02）、先前暴露于化疗（p<0.001）和病变大小<1cm（p<0.001）。
尽管 MRI 取得了进展，但本研究表明，在微创肝手术期间进行 LUS 检查可能会在 10%的肝恶性肿瘤患者中检测到额外的肿瘤，肥胖且有化疗暴露史的患者的检出率最高。这些结果支持肝外科医生常规使用 LUS。
