INTRAOPERATIVE ULTRASONOGRAPHY IN THE DIAGNOSIS OF HEPATIC METASTASESDURING SURGERY FOR COLORECTAL-CANCER

Approximately 20 - 25% of colorectal cancers have hepatic metastases a t the time of operation and occult liver secondaries appear in 10 - 30 % of curatively operated cases. Intraoperative liver ultrasonography h as been reported to be the most accurate method for detecting colorect al metastases. A consecutive series of 119 colorectal cancer patients was studied by routine extracorporeal preoperative ultrasound (EUS), i nspection and palpation of the liver at laparotomy and intraoperative liver ultrasound (IUS). 19 patients had liver metastases at the time o f surgery. In eight, diagnosis was by EUS. Inspection and palpation yi elded a further seven, and IUS alone a further four. Additional lesion s were detected in 3 patients after preoperative ultrasound and in 6 p atients following 3 cases IUS demonstrated additional metastases. Foll ow up for a median 38 months (12-59) was by clinical examination and s ix monthly liver ultrasound. During this time 8 patients, who were tho ught to have a clear liver, developed hepatic metastases. The mean tim e from surgery to the detection of occult hepatic metastases was 14.7 (8-26) months and 4 of these appeared in the second year. Intraoperati ve ultrasonography is a sensitive and useful method in detecting liver metastases, and may improve clinical staging and the selection of pat ients for further therapy. However some occult hepatic metastases will remain undetected.