Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: A prospective database study

Objective To present the survival results for patients with colorectal carc inoma metastases who have undergone liver resection after being staged by [ F-18] flouro-2-deoxy-D-glucose-positron emission tomography (FDG-PET). Summary Background Data Hepatic resection is standard therapy for colorecta l metastases confined to the liver, but recurrence is common because of the presence of undetected cancer at the time of surgery. FDG-PET is a sensiti ve diagnostic tool that identifies tumors based on the increased uptake of glucose by tumor cells. To date, no survival results have been reported for patients who have actually had liver resection after being staged by FDG-P ET. Methods Forty-three patients with metastatic colorectal cancer were referre d for hepatic resection after conventional tumor staging with computed tomo graphy. FDG-PET was performed on all patients. Laparotomy was performed on patients not staged out by PET. Resection was performed at the time of lapa rotomy unless extrahepatic disease or unresectable hepatic tumors were foun d. Patients were examined at intervals in the preoperative period. Results FDG-PET identified additional cancer not seen on computed tomograph y in 10 patients. Surgery was contraindicated in six of these patients beca use of the findings on FDG-PET. Laparotomy was performed in 37 patients. In ail but two, liver resection was peformed. Median follow-up in the 35 pati ents undergoing resection was 24 months. The Kaplan-Meier estimate of overa ll survival at 3 years was 77% and the lower 95% confidence limit of this e stimate of survival was 60%. This figure is higher than 3-year estimate of survival found in previously published series. The 5-year disease-free surv ival rate was 40%. Conclusions Preoperative FDG-PET lessens the recurrence rate in patients un dergoing hepatic resection for colorectal metastases to the liver by detect ion of disease not found on conventional imaging.