Prospective, blinded comparison of laparoscopic ultrasonography vs. contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery

PURPOSE: To prospectively and blindly compare intraoperative laparoscopic u ltrasonography to preoperative contrast-enhanced computerized tomography in detecting liver lesions in colorectal cancer patients. Additionally, we co mpared conventional (open) intraoperative ultrasonography with bimanual liv er palpation to contrast-enhanced computerized tomography in a subset of pa tients. METHODS: From December 1995 to March 1998, 77 consecutive patients underwent curative (n = 63) or palliative (n = 14) resections for colorecta l cancer. All patients undergoing curative resections were randomized to ei ther laparoscopic (n = 34) or conventional (n = 29) surgery after informed consent. All patients underwent contrast-enhanced computerized tomography, diagnostic laparoscopy, and laparoscopic ultrasonography. before resection. In those patients who had conventional procedures, intraoperative ultrason ography with bimanual liver palpation was also done. All laparoscopic ultra sonography and intraoperative ultrasonography evaluations were performed by one of two radiologists who n ere blinded to the CT results. All hepatic s egments were scanned using a standardized method. The yield of each modalit y was calculated using the number of lesions identified by each imaging mod ality divided by the total number of Lesions identified. RESULTS: In 43 of the 77 patients, both the laparoscopic ultrasonography and CT scan were neg ative for any liver lesions. In 34 patients, a total of 130 lesions were de tected by laparoscopic ultrasonography, CT, or both. When compared with lap aroscopic ultrasonography, intraoperative ultrasonography with bimanual liv er palpation identified one additional metastatic lesion and no additional benign lesions, laparoscopic ultrasonography identified two patients with m ets who had negative preoperative contrast-enhanced computerized tomography . CONCLUSIONS: Laparoscopic ultrasonography of the liver at the time of pri mary resection of colorectal cancer yields more lesions than preoperative c ontrast-enhanced computerized tomography and should be considered for routi ne use during laparoscopic oncologic colorectal surgery.