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Ultraschall Med
DOI: 10.1055/a-2249-6791
Original Article

Intraoperative contrast-enhanced ultrasound has an outcome-relevant impact on surgery of primary and metastatic liver lesions

Intraoperativer kontrastmittelverstärkter Ultraschall beeinflusst klinisch relevant das chirurgische Outcome von primären Lebertumoren und Lebermetastasen
Florian Bitterer 
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
,
Andreas Bauer
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
,
Gunther Glehr
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
,
Stefan Brunner
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
,
Katharina Schmidt
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
,
Hans Jürgen Schlitt
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
,
Ernst Michael Jung
2   Department of Radiology, University Hospital Regensburg, Regensburg, Germany
,
Christina Hackl
1   Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT05261113, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: prospective, monocentric, non-interventional observational study
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Abstract

Purpose Complete resection of the affected tissue remains the best curative treatment option for liver-derived tumors and colorectal liver metastases. In addition to preoperative cross-sectional imaging, contrast-enhanced intraoperative ultrasound (CE-IOUS) plays a crucial role in the detection and localization of all liver lesions. However, its exact role is unclear. This study was designed to evaluate the clinical and oncological impact of using CE-IOUS in the surgical treatment of these diseases.

Materials and Methods Over the three-year study period, 206 patients with primary liver tumors and hepatic metastases were enrolled in this prospective, monocentric study to evaluate the impact of CE-IOUS in liver surgery. Secondary outcomes included comparing the sensitivity and specificity of CE-IOUS with existing preoperative imaging modalities and identifying preoperative parameters that could predict a strategic impact of CE-IOUS. In addition, the oncological significance of CE-IOUS was evaluated using a case-cohort design with a minimum follow-up of 18 months.

Results CE-IOUS findings led to a change in surgical strategy in 34% of cases (n=70/206). The accuracy in cases with a major change could be confirmed histopathologically in 71.4% of cases (n=25/35). The impact could not be predicted using parameters assumed to be clinically relevant. An oncological benefit of a CE-IOUS adapted surgical approach was demonstrated in patients suffering from HCC and colorectal liver metastases.

Conclusion CE-IOUS may significantly increase R0 resection rates and should therefore be used routinely as an additional staging method, especially in complex liver surgery.

Zusammenfassung

Ziel Die Resektion primärer Lebertumore und kolorektaler Lebermetastasen ist die beste kurative Behandlungsmöglichkeit. Für deren Planung spielt – neben der präoperativen Schnittbildgebung – der kontrastmittelverstärkte intraoperative Ultraschall (CE-IOUS) eine entscheidende Rolle. Sein tatsächlicher klinischer Einfluss ist jedoch nicht vollständig geklärt und folglich Gegenstand dieser Studie.

Materialien und Methoden 206 Patienten mit primären Lebertumoren und Lebermetastasen wurden in diese prospektive, monozentrische Studie eingeschlossen, um den klinischen Einfluss des CE-IOUS in der Leberchirurgie zu evaluieren. Zu den sekundären Endpunkten gehörten der Vergleich seiner Sensitivität und Spezifität gegenüber der präoperativen Bildgebung sowie die Identifizierung von Parametern, die einen strategischen Effekt des CE-IOUS vorhersagen können. Darüber hinaus wurde die onkologische Relevanz des CE-IOUS anhand eines Fall-Kohorten-Designs mit einer Nachbeobachtungszeit von mindestens 18 Monaten evaluiert.

Ergebnisse CE-IOUS-Befunde führten in 34% (n=70/206) zu einer Änderung der chirurgischen Strategie. In 71,4% (n=25/35) der Fälle mit signifikanter Einflussnahme bestätigte sich die Korrektheit histopathologisch. Anhand präoperativer Parameter, die als klinisch relevant eingeschätzt werden, ließen sich die Effekte nicht vorhersagen. Für Patienten mit HCC und kolorektalen Lebermetastasen zeigte sich ein onkologischer Nutzen eines an CE-IOUS angepassten chirurgischen Vorgehens.

Schlussfolgerung CE-IOUS kann die R0-Resektionsraten signifikant erhöhen und sollte daher routinemäßig als zusätzliche Staging-Methode, insbesondere bei komplexen Leberoperationen, eingesetzt werden.

Keywords

contrast-enhanced intraoperative ultrasound (CE-IOUS) - liver surgery - liver cancer - colorectal liver metastases (CRLM)

Supplementary Material



Publication History

Received: 19 September 2023

Accepted after revision: 17 January 2024

Article published online:
09 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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