Selection of Patients for Resection of Hepatic Colorectal Metastases: 18F-Fluorodeoxyglucose/Positron Emission Tomography

  • Rebecca Auer
  • Yuman Fong
Part of the Methods of Cancer Diagnosis, Therapy and Prognosis book series (HAYAT, volume 5)

The selection of appropriate patients for surgical resection of colorectal liver metas-tases is a central clinical dilemma. Using conventional imaging, up to one quarter of patients scheduled for surgical resection will be determined to have unresectable or metastatic disease at the time of surgery. Of the patients who do undergo a resection with curative intent, ~ 60% will develop a recurrence within 3 years, either within the liver or in an extrahepatic location (Bines et al., 1996). It is clear that a more effective preoperative staging modality is needed to avoid unsuccessful or ineffective surgeries.

Positron emission tomography (PET) using [18F]fluorodeoxyglucose (FDG) is emerging as a promising diagnostic modality in metastatic colorectal cancer. [18F] fluorodeoxyglucose-positron emission tomography (FDG-PET) has the potential to differentiate between patients with resectable and unresectable hepatic colorectal cancer metastases and therefore improve patient selection for surgery with a positive effect on surgical treatment outcomes, including survival. Positron emission tomography may improve the survival time in patients undergoing hepatic resection for metastatic colorectal cancer for three reasons. First, if preop-erative workup with PET scanning detects more extrahepatic disease than conventional imaging alone, surgery would not be undertaken in these patients, and the group of patients undergoing surgery would have a more favorable prognosis; a concept similar to the Will-Rogers effect, which is used to describe stage migration. Second, if hepatic recurrences are detected earlier in patients screened with PET scanning as compared to conventional imaging alone, surgery would be performed earlier and survival, as defined from the time of metastasectomy, would be longer, a concept termed lead-time bias. Third, if hepatic recurrences are detected earlier with PET scan, surgery might be undertaken prior to the development of additional systemic micrometastases. Based on tumor biology, this results in a true improvement in survival.


Positron Emission Tomography Hepatic Resection Hepatic Metastasis Metastatic Colorectal Cancer Colorectal Liver Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Akhurst, T., Kates, T.J., Mazumdar, M., Yeing, H., Riedel, E.R., Burt, B.M., Blumgart, L.H., Jarnagin, W., Larson, S.M., and Fong, Y. 2005. Recent chemotherapy reduces the sensitivity of [18F]fluorodeoxyglucose positron emission tomography in the detection of colorectal metas-tases. J. Clin. Oncol. 23:8713–8716.PubMedCrossRefGoogle Scholar
  2. Bines, S.D., Doolas, L., Jenkins, L., Millikan, K., and Roseman, D.L. 1996. Survival after repeat hepatic resection for recurrent colorectal hepatic metastases. Surgery 120:591–596.PubMedCrossRefGoogle Scholar
  3. Bozzetti, F., Bignami, R., Montalto, F., Doci, R., and Gennari, L. 1992. Repeated hepatic resection for recurrent metastases from colorectal cancer. Br. J. Surg. 79:146–148.PubMedCrossRefGoogle Scholar
  4. Delbeke, D., Vitola, J.V., Sandler, M.P., Arildsen, R.C., Powers, T.A., Wright, J.K. Jr., Chapman, W.C., and Pinson, C.W. 1997. Staging recurrent metastatic colorectal carcinoma with PET. J. Nucl. Med. 38:1196–1201.PubMedGoogle Scholar
  5. DeMatteo, R.P., Minnard, E.A., Kemeny, N., Downey, R., Burt, B.M., Fong, Y., and Blumgart, L.H. 1999. Outcome after resection of both liver and lung metastases in patients with colorectal cancer. ASCO Annual Meeting, abstract.Google Scholar
  6. Dimitrakopoulou-Strauss, A., Strauss, L.G., and Rudi, J. 2003. PET-FDG as predictor of therapy response in patients with colorectal carcinoma. Q. J. Nucl. Med. 47:8–13.PubMedGoogle Scholar
  7. Fernandez, F.G., Drebin, J.A., Linehan, D.C., Dehdashti, B., Siegel, B.A., and Strasberg, S.M. 2004. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann. Surg. 240:438–447.PubMedCrossRefGoogle Scholar
  8. Findlay, M., Young, H., Cunningham, D., Iveson, A., Cronin, B., Hickish, T., Pratt, B., Husband, J., Flower, M., and Ott, R. 1996. Noninvasive monitoring of tumor metabolism using fluorode-oxyglucose and positron emission tomography in colorectal cancer liver metastases: correlation with tumor response to fluorouracil. J. Clin. Oncol. 14:700–708.PubMedGoogle Scholar
  9. Flamen, P., Hoekstra, O.S., Homans, F., Flamen, P., Hoekstra, O.S., Homans, F., Van Cutsem, E., Maes, A., Stroobants, S., Peeters, M., Penninckx, F., Filez, L., Bleichrodt, R.P., and Mortelmans, L. 2001. Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron tomography (PET). Eur. J. Cancer 37:862–869.PubMedCrossRefGoogle Scholar
  10. Flanagan, F.L., Dehdashti, F., Ogunbiyi, O.A., Kodner, I.J., and Siegel, B.A. 1998. Utility of FDG-PET for investigating unexplained plasma CEA elevation in patients with colorectal cancer. Ann. Surg. 227:319–323.PubMedCrossRefGoogle Scholar
  11. Fong, Y., Fortner, J., Sun, R.L., Brennan, M.F., and Blumgart, L.H. 1999a. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann. Surg. 230:309–318.CrossRefGoogle Scholar
  12. Fong, Y., Saldinger, P.F., Akhurst, T., Macaplinac, H., Yeung, H., Finn, R.D., Cohen, A., Kemeny, N., Blumgart, L.H., and Larson, S.M. 1999b. Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases. Am. J. Surg. 178:282–287.CrossRefGoogle Scholar
  13. Guillem, J.G., Moore, H.G., Akhurst, T., Klimstra, D.S., Ruo, L., Mazumdar, M., Minsky, B.D., Gollub, M.J., Saltz, L., Wong, W.D., and Larson, S. 2004. Sequential preoperative fluorodeoxyglu-cose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining long term outcomes of rectal cancer. J. Am. Coll. Surg. 199:1–7.PubMedCrossRefGoogle Scholar
  14. Jaeck, D., Nakano, H., Bachellier, P., Inoue, K., Weber, J.C., Oussoultzoglou, E., Wolf, P., and Chenard-Neu, M.P. 2002. Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study. Ann Surg. Oncol. 9:430–438.PubMedCrossRefGoogle Scholar
  15. Jarnagin, W.R., Conlon, J., Bodniewicz, J., Dougherty, E., DeMatteo, R.P., Blumgart, L.H., and Fong, Y. 2001. A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases. Cancer 91:1121–1128.PubMedCrossRefGoogle Scholar
  16. Nakashima, R.A., Paggi, M.G., and Pederson, P.L. 1984. Contributions of glycolysis and oxidative phosphorylation to adenosine 5′-triphosphate production in AS-30D hepatoma cells. Cancer Res. 44:5702–5706.PubMedGoogle Scholar
  17. Pauwels, E.K., Sturm, E.J., Bombardieri, E., Cleton, F.J., and Stokkel, M.O. 2000. Positron-emission tomography with [18F]fluorodeoxy-glucose. Part I. Biochemical uptake mechanism and its implications for clinical studies. J. Can. Res. Clin. Oncol. 126:549–559.CrossRefGoogle Scholar
  18. Rohren, E.M., Paulson, E.K., Hagge, R., Wong, T.Z., Killius, J., Clavien, P.A., and Nelson, R.C. 2002. The role of F-18 FDG positron emission tomography in preoperative assessment of the liver in patients being considered for curative resection of hepatic metastases from colorectal cancer. Clin. Nucl. Med. 27:550–555.PubMedCrossRefGoogle Scholar
  19. Rosen, C.B., Nagorney, D.M., Taswell, H.F., Helgeson, S.L., Illstrup, D.M., Van Heerden, J.A., and Adson, M. 1992. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann. Surg. 216:492–505.CrossRefGoogle Scholar
  20. Ruers, T.J., Langenhoff, B.S., Neeleman, N., Jager, G.J., Strijk, S., Wobbes, T., Corstens, F.H., and Oyen, W.J. 2002. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J. Clin. Oncol. 20:388–395.PubMedCrossRefGoogle Scholar
  21. Rydzewski, B., Dehdashti, F., Gordon, B.A., Teefey, S.A., Strasberg, S.M., and Siegel, B.A. 2002. Usefulness of intraoperative sonography for revealing hepatic metastases from colorec-tal cancer in patients selected for surgery after undergoing FDG PET. AJR. Am. J. Roentgenol. 178:353–358.PubMedGoogle Scholar
  22. Schussler-Fiorenza, C.M., Mahvi, D.M., Niederhuber, J., Rikkers, L.F., and Weber, S.M. 2004. Clinical risk score correlates with yield of PET scan in patients with colorec-tal hepatic metastases. J. Gastrointest. Surg. 8:150–157.PubMedCrossRefGoogle Scholar
  23. Selzner, M., Hany, T.F., Wildbrett, P., McCormack, L., Kadry, Z., and Clavien, P.A. 2004. Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer to the liver? Ann. Surg. 204:1027–1034.CrossRefGoogle Scholar
  24. Strasberg, S.M., Dehdashti, F., Siegel, B.A., Drebin, J.A., and Linehan, D. 2001. Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann. Surg. 233:293–299.PubMedCrossRefGoogle Scholar
  25. Taylor, I. 1996. Liver metastases from colorectal cancer: lessons from past and present clinical studies. Br. J. Surg. 83:456–460.PubMedCrossRefGoogle Scholar
  26. Truant, S., Huglo, D., Hebbar, M., Ernst, O., Steinling, M., and Pruvot, F.R. 2005. Prospective evaluation of the impact of [18F]fluoro-2-deoxy-D-glucose positron emission tomography of resectable colorectal liver metastases. Br. J. Surg. 92:362–369.PubMedCrossRefGoogle Scholar
  27. Wiering, B., Krabbe, P.F., Jager, G.J., Oyen, W.J., and Ruers, T.J. 2005. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer 104:2658–2670.PubMedCrossRefGoogle Scholar
  28. Young, H., Baum, R., Cremerius, U., Herholz, K., Hoekstra, O., Lammertsma, A., Pruim, J., and Price, P. 1999. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 ORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur. J. Cancer 35:1773–1782.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Rebecca Auer
    • 1
  • Yuman Fong
    • 2
  1. 1.Centre for Cancer TherapeuticsOttawa Health Research InstituteOttawaCanada
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer Center, Weill Cornell Medical CenterNew YorkUSA

Personalised recommendations