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


Authors: Kingham, T. P.; Pak, L. M.; Simpson, A. L.; Leung, U.; Doussot, A.; D'Angelica, M. I.; DeMatteo, R. P.; Allen, P. J.; Jarnagin, W. R.
Article Title: 3D image guidance assisted identification of colorectal cancer liver metastases not seen on intraoperative ultrasound: Results from a prospective trial
Abstract: 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. © 2017 International Hepato-Pancreato-Biliary Association Inc.
Keywords: adult; cancer chemotherapy; clinical article; controlled study; aged; cancer surgery; cancer localization; outcome assessment; antineoplastic agent; controlled clinical trial; drug effect; three dimensional imaging; clinical effectiveness; fatty liver; peroperative echography; preoperative chemotherapy; colorectal liver metastasis; human; male; female; article
Journal Title: HPB
Volume: 20
Issue: 3
ISSN: 1365-182X
Publisher: Elsevier Science, Inc.  
Date Published: 2018-03-01
Start Page: 260
End Page: 267
Language: English
DOI: 10.1016/j.hpb.2017.08.035
PROVIDER: scopus
PUBMED: 28935452
DOI/URL:
Notes: Article -- Export Date: 2 April 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Ronald P Dematteo
    558 Dematteo
  2. Peter Allen
    398 Allen
  3. William R Jarnagin
    533 Jarnagin
  4. T Peter Kingham
    259 Kingham
  5. Amber L Simpson
    40 Simpson
  6. Universe Yu Hang Leung
    12 Leung
  7. Alexandre Florent Doussot
    14 Doussot
  8. Linda Ma
    14 Ma