Intraoperative liver ultrasound still affects surgical strategy for patients with colorectal metastases in the modern era

World J Surg. 2013 Nov;37(11):2655-63. doi: 10.1007/s00268-013-2183-6.


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.

MeSH terms

  • Colorectal Neoplasms / pathology*
  • Contrast Media
  • Diagnostic Imaging
  • Female
  • Hepatectomy / methods*
  • Humans
  • Image Enhancement
  • Image Processing, Computer-Assisted
  • Intraoperative Care / methods
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Multiple Primary / diagnostic imaging*
  • Neoplasms, Multiple Primary / surgery*
  • Phospholipids
  • Retrospective Studies
  • Sulfur Hexafluoride
  • Treatment Outcome
  • Ultrasonography, Interventional / methods*


  • Contrast Media
  • Phospholipids
  • contrast agent BR1
  • Sulfur Hexafluoride