PREOPERATIVE DETERMINATION OF THE RESECTABILITY OF HEPATIC-TUMORS - EFFICACY OF CT DURING ARTERIAL PORTOGRAPHY

OBJECTIVE. A multiinstitutional study was performed to evaluate the ef ficacy of CT during arterial portography for determining the resectabi lity of hepatic tumors. The impact of findings from CT during arterial portography on patients' treatment (i.e., surgical vs nonsurgical) wa s assessed. In patients considered to have resectable tumors, the accu racy of CT during arterial portography for predicting surgical finding s was also evaluated. MATERIALS AND METHODS. A retrospective study was done of 404 patients from three institutions who had CT during arteri al portography during the period 1985-1991 as part of preoperative sta ging to determine the resectability of hepatic tumors. The tumors incl uded metastases from colorectal carcinoma in 197 patients (49%); other hepatic metastases, mostly from adenocarcinoma of the stomach, pancre as, and biliary tree in 123 (30%); and primary hepatocellular carcinom a in 84 (21%). Imaging results were correlated with results of percuta neous biopsy of at least one hepatic lesion in patients whose tumors w ere considered unresectable. In patients whose tumors were considered resectable, results were correlated with preoperative percutaneous bio psy (obtained in almost all cases) and pathologic examination of a sur gical specimen (all cases). Although each case was considered individu ally, four criteria were used for resectability: (1) accessibility of all lesions to lobar or wedge resection that would yield clear margins , (2) anticipation that residual liver tissue after resection would pr ovide sufficient function, (3) the absence of invasion of central hepa tic vascular or biliary structures, and (4) the absence of extrahepati c disease. No specific restriction was made with respect to the number of hepatic lesions present. The accuracy of findings by CT during art erial portography for predicting resectability was assessed in the 146 patients who had tumors that were considered resectable on the basis of imaging findings and had surgery. RESULTS. Of 404 patients, only 14 6 (36%) were thought to be candidates for resection on the basis of fi ndings from CT during arterial portography. Of these, 122 (84%) actual ly had resection. The 24 patients who did not have resection included 22 patients with disease understaged or overstaged by CT during arteri al portography, one with true-negative findings by CT during arterial portography, and one who died during surgery. The accuracy of findings by CT during arterial portography for predicting results at surgery w as 85% for all patients and 91% for the subset of patients who had pri mary colorectal tumors with hepatic metastases. CONCLUSION. Our experi ence shows that CT during arterial portography is a useful procedure f or assessing the resectability of hepatic tumors. In our study, 64% of patients were spared unnecessary surgery. Only 13% of patients in who m tumors were considered resectable on the basis of findings by CT dur ing arterial portography were found during surgery to have unresectabl e disease.