Advertisement

Contrast-enhanced intraoperative ultrasound in the resection of colorectal liver metastases with intrabiliary growth

  • Junko Hiroyoshi
  • Suguru Yamashita
  • Mariko Tanaka
  • Akimasa Hayashi
  • Tetsuo Ushiku
  • Junichi Kaneko
  • Nobuhisa Akamatsu
  • Junichi Arita
  • Yoshihiro Sakamoto
  • Kiyoshi Hasegawa
Case Report
  • 65 Downloads

Abstract

A 68-year-old male who had undergone low anterior resection for primary rectal cancer 19 months ago presented with multiple CLM at Couinaud’s segments IV, V, and VIII. There was no apparent macroscopic intrabiliary growth on preoperative computed tomography and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI). However, the hepatobiliary phase of EOB-MRI revealed peritumoral low signal intensity in lesions in segments V and VIII, which indicates vascular invasion around hepatocellular carcinoma. Contrast-enhanced intraoperative ultrasound (CE-IOUS) clearly determined the extent of macroscopic glissonean growth from lesions in segments V and VIII, and more extensive resection was performed than was planned. Analysis of the resected specimens from segments V and VIII confirmed the presence of macroscopic intrabiliary growth with microscopic portal vein invasion. All three CLM were histopathologically diagnosed as well-to-moderately differentiated adenocarcinoma, and R0 resection was verified. Postoperative recovery was uneventful, and the patient was alive without evidence of recurrence 12 months after hepatic resection. CE-IOUS should be considered at the time of CLM resection, as it might enable more accurate detection of macroscopic intrabiliary growth of CLM, and enable resection with safer margins.

Keywords

Colorectal liver metastases Macroscopic intrabiliary growth Contrast-enhanced intraoperative ultrasound 

Abbreviations

CLM

Colorectal liver metastases

CT

Computed tomography

EOB-MRI

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging

CE-IOUS

Contrast-enhanced intraoperative ultrasound

Notes

Acknowledgements

We thank Kelly Zammit, BVSc, from Edanz Group (http://www.edanzediting.com/ac), for editing a draft of this manuscript.

Author contributions

JH and KH performed the operation. JH and SY drafted the manuscript, and KH revised the manuscript. MT, AH, and TU made the pathological diagnosis. All authors read and approved the final manuscript.

Funding

This work was supported by grants from the JSPS KAKENHI (Grant number 17K16532) and the Tokyo Society of Medical Sciences.

Compliance with ethical standards

Conflict of interest

Junko Hiroyoshi, Mariko Tanaka, Akimasa Hayashi, Tetsuo Ushiku, Junichi Kaneko, Nobuhisa Akamatsu, Junichi Arita, Yoshihiro Sakamoto and Kiyoshi Hasegawa declare that they have no conflict of interest. Suguru Yamashita received a research grant from JSPS KAKENHI(17K16532) and Tokyo Society of Medical Science.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Yasui K, Hirai T, Kato T, et al. A new macroscopic classification predicts prognosis for patient with liver metastases from colorectal cancer. Ann Surg. 1997;226:582–6.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Okano K, Yamamoto J, Moriya Y, et al. Macroscopic intrabiliary growth of liver metastases from colorectal cancer. Surgery. 1999;126:829–34.CrossRefPubMedGoogle Scholar
  3. 3.
    Kubo M, Sakamoto M, Fukushima N, et al. Less aggressive features of colorectal cancer with liver metastases showing macroscopic intrabiliary extension. Pathol Int. 2002;52:514–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim KA, Kim MJ, Jeon HM, et al. Prediction of microvascular invasion of hepatocellular carcinoma: usefulness of peritumoral hypointensity seen on gadoxetate disodium-enhanced hepatobiliary phase images. J Magn Reson Imaging. 2012;35:629–34.CrossRefPubMedGoogle Scholar
  5. 5.
    Estrella JS, Othman ML, Taggart MW, et al. Intrabiliary growth of liver metastases: clinicopathologic features, prevalence, and outcome. Am J Surg Pathol. 2013;37:1571–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sugiura T, Nagino M, Oda K, et al. Hepatectomy for colorectal liver metastases with macroscopic intrabiliary tumor growth. World J Surg. 2006;30:1902–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Kon T, Suzuki H, Kawaguchi T, et al. Anatomical hepatectomy for liver metastasis from rectal adenocarcinoma presenting with intrabiliary extension: a case report. J Rural Med. 2016;11:63–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fujii M. Using preoperative UFT to predict sensitivity to fluoropyrimidines in colorectal cancer. Oncology (Williston Park). 1999;13:55–60.Google Scholar
  9. 9.
    Arita J, Takahashi M, Hata S, et al. Usefulness of contrast-enhanced intraoperative ultrasound using Sonazoid in patients with hepatocellular carcinoma. Ann Surg. 2011;254:992–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Miyata A, Ishizawa T, Tani K, et al. Reappraisal of a dye-staining technique for anatomic hepatectomy by the concomitant use of indocyanine green fluorescence imaging. J Am Coll Surg. 2015;221:e27–36.CrossRefPubMedGoogle Scholar
  11. 11.
    Are C, Gonen M, Zazzali K, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg. 2007;246:295–300.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mise Y, Aloia TA, Brudvik KW, et al. Parenchymal-sparing hepatectomy in colorectal liver metastasis improves salvageability and survival. Ann Surg. 2016;263:146–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Povoski SP, Klimstra DS, Brown KT, et al. Recognition of intrabiliary hepatic metastases from colorectal adenocarcinoma. HPB Surg. 2000;11:383–90.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Okano K, Yamamoto J, Okabayashi T, et al. CT imaging of intrabiliary growth of colorectal liver metastases: a comparison of pathological findings of resected specimens. Br J Radiol. 2002;75:497–501.CrossRefPubMedGoogle Scholar
  15. 15.
    Muramatsu Y, Takayasu K, Furukawa Y, et al. Hepatic tumor invasion of bile ducts: wedge-shaped sign on MR images. Radiology. 1997;205:81–5.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Junko Hiroyoshi
    • 1
  • Suguru Yamashita
    • 1
  • Mariko Tanaka
    • 2
  • Akimasa Hayashi
    • 2
  • Tetsuo Ushiku
    • 2
  • Junichi Kaneko
    • 1
  • Nobuhisa Akamatsu
    • 1
  • Junichi Arita
    • 1
  • Yoshihiro Sakamoto
    • 1
  • Kiyoshi Hasegawa
    • 1
  1. 1.Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Pathology, Graduate School of MedicineThe University of TokyoTokyoJapan

Personalised recommendations