Selection of Patients for Resection of Hepatic Colorectal Metastases: 18F-Fluorodeoxyglucose/Positron Emission Tomography
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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.
KeywordsPositron Emission Tomography Hepatic Resection Hepatic Metastasis Metastatic Colorectal Cancer Colorectal Liver Metastasis
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