title: Intraoperative liver ultrasound still affects surgical strategy for patients with colorectal metastases in the modern era.
abstract: BACKGROUND
  The present study was designed to evaluate the role of intraoperative ultrasound (IOUS) in intrahepatic staging and the impact on surgical strategy for patients with colorectal liver metastases (CRLM).
  
  
  METHODS
  The study included 515 patients who had undergone liver resection for CRLM at two tertiary care referral centers. Data from a prospectively collected database were retrospectively analysed. Early intrahepatic recurrence was assessed at 3 and 6 months after resection and was considered as residual disease undetected by IOUS. Performance of imaging modalities was compared by analysis of studies on individual patients.
  
  
  RESULTS
  A total of 1,370 liver metastases were detected preoperatively with a median of 3 imaging modalities. MRI and PET were performed in 51 and 42 % of the patients, respectively. Median number of days between last imaging and surgery was 18. Contrast-enhanced IOUS was performed in 136 patients (26.4 %). Intraoperatively, 293 new nodules were found in 132 patients: on histology 280 were CRLM (17.6 %). Surgical strategy was changed in 140 patients (27.2 %). On multivariate analysis synchronous and bilobar metastases ≥ 3 in number, BMI ≥ 30, and time between last imaging and surgery longer than 18 days resulted in predictive factors indicating new nodules detected by IOUS. Early intrahepatic recurrences were 3.7 and 7.9 % at 3 and 6 months. Performance of CT, MRI, FDG-PET, and intraoperative staging was compared: sensitivity was 63.6, 68.8, 53.6, and 92 % and specificity was 91, 92.3, 95.8, and 97.8 %, respectively
  
  
  CONCLUSIONS
  The use of IOUS continues to be mandatory for correct staging of patients with CRLM undergoing liver resection.
authors: Department of Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy, aferrero@mauriziano.it.
authors: Alessandro
authors: A
authors: Ferrero
authors: Serena
authors: S
authors: Langella
authors: Felice
authors: F
authors: Giuliante
authors: Luca
authors: L
authors: Viganò
authors: Maria
authors: M
authors: Vellone
authors: Giuseppe
authors: G
authors: Zimmitti
authors: Francesco
authors: F
authors: Ardito
authors: Gennaro
authors: G
authors: Nuzzo
authors: Lorenzo
authors: L
authors: Capussotti
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D003952:Diagnostic Imaging; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007430:Intraoperative Care / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D010743:Phospholipids; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
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