Inferior vena cava (IVC) preservation during orthotopic liver transplantation (OLT) is known as t... more Inferior vena cava (IVC) preservation during orthotopic liver transplantation (OLT) is known as the "piggyback" technique. The end-to-side anastomosis is constructed between the graft's IVC and recipient's hepatic veins using a Satinsky side clamp applied in a transverse position. To stabilize the large Satinsky clamp and preserve a sufficient vascular stump after hepatectomy and before graft implantation, we propose a technical innovation consisting of hanging the septa between the left and middle hepatic vein and between the middle and right hepatic vein using 2 tapes. This technique showed some advantages when performing the caval outflow anastomosis, representing a further technical refinement of the piggyback end-to-side technique for the implantation on the 3 hepatic veins. From November 2001 to September 2012, we performed 272 consecutive OLT at our institution with the piggyback technique using the hanging of the hepatic veins septa in all cases. In conclusion, the hanging of the 3 hepatic veins septa presented in this study represents a simple, safe and reproducible technique for the outflow anastomosis using the piggyback technique.
Disponible sur Internet le 17 décembre 2015 MOTS CLÉS Carcinose péritonéale ; Tumeur rare ; Chimi... more Disponible sur Internet le 17 décembre 2015 MOTS CLÉS Carcinose péritonéale ; Tumeur rare ; Chimiohyperthermie intrapéritonéale ; Chirurgie Résumé Introduction.-Une chirurgie de cytoréduction complète (CCRC) plus chimiohyperthermie intrapéritonéale (CHIP) est le traitement curatif de référence des carcinoses péritonéales (CP) d'origine colorectale, des pseudomyxomes et des mésothéliomes péritonéaux. Ses résultats restent controversés dans les CP d'origine ovarienne, gastrique, neuroendocrine ou sarcomateuse. Ce traitement a aussi été utilisé de façon beaucoup plus inhabituelle dans d'autres pathologies, exceptionnelles en raison de leur rareté ou du caractère rarement isolé de la CP. Le but de ce travail était d'évaluer les résultats d'une CCRC plus CHIP chez les patients avec une CP inhabituelle. Méthodes.-Tous les patients traités par CCRC plus CHIP d'une CP non colorectale, non gastrique, non neuroendocrine, non pseudomyxome, non mésothéliome, non ovarienne et non sarcomateuse ont été rétrospectivement analysés. Résultats.-Entre 1995 et 2013, 31 patients ont été opérés pour une CP issue de 15 étiologies inhabituelles. Après un suivi médian de 90 mois, 10 patients étaient vivants et sans récidive. Le taux de survie globale à 5 ans était de 33 % et la survie médiane de 37 mois. En analyse univariée, les facteurs de mauvais pronostic et prédictifs de récidive étaient la réalisation d'une chimiothérapie intrapéritonéale postopératoire immédiate par rapport à une CHIP et un index péritonéal supérieur ou égal à 12. Aucun impact pronostique de l'origine tumorale n'a pu être démontré.
Background: Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treate... more Background: Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treated by surgical resection. The aim of this study was to evaluate the feasibility, morbidity and mortality of a laparoscopic approach in cirrhotic patients with HCC. Methods: From 2004 to September 2014, 90 patients underwent a laparoscopic liver resection (LLR) for HCC. Data were collected in a prospectively maintained database since 2001. Preoperative patient evaluation was based on a multidisciplinary team meeting assessment. Results: Median age was 63 years; 67 (74.4%) patients were male. Median body mass index (BMI) was 26.7. Underlying liver disease was known in 68 patients: in 46 patients' hepatitis C virus (HCV)-related, in 15 patients to hepatitis B virus (HBV)-related, in 5 patients alcohol-related. Child-Pugh Score was of grade A in 85 patients and of grade B in 5 patients; 63 patients had a Model for End-stage Liver Disease (MELD) <10 and 27 patients MELD >10. A total of 18 left lateral sectionectomies, 1 left hepatectomy and 71 wedge resections or segmentectomies were performed. Conversion to laparotomy was necessary in 7 (7.7%) patients (five cases for bleeding and two cases for oncological reasons). In 90 patients, 98 HCC nodules were resected: 79 patients had one nodule, 8 patients had two nodules and 1 patient had three nodules. HCC nodules medium diameter was 29 mm (range, 4-100 mm) with median value of 25 mm. Tumor margins distance was 16 mm (range, 0-35 mm) with a median of 5 mm. Seventy nodules were located within the anterior sectors and 28 nodules within the posterior sectors. Conclusions: LLR for HCC can be performed with acceptable morbidity in patients with underlying liver disease. The use of laparoscopic surgery in cirrhotic patients may be proposed as the first-line treatment for HCC or as bridge treatment before liver transplantation.
Metastasis is the primary cause of death in patients with colorectal cancer (CRC), urging the nee... more Metastasis is the primary cause of death in patients with colorectal cancer (CRC), urging the need for preclinical models that recapitulate the metastatic process at the individual patient level. We used an orthotopic patient-derived xenograft (PDX) obtained through the direct implantation of freshly dissociated CRC cells in the colon of immunocompromised mice to model the metastatic process. Ortho-PDX engraftment was associated to a specific set of molecular features of the parental tumor, such as epithelial-to-mesenchymal transition (EMT), TGF-β pathway activation, increased expression of stemness-associated factors and higher numbers of circulating tumor cells (CTCs) clusters expressing the metastatic marker CD44v6. A parallel analysis of orthotopic/metastatic xenografts and organoids showed that tumor cells underwent mesenchymal-to-epithelial transition at the metastatic site and that metastasis-derived organoids had increased chemotherapy resistance. These observations support ...
Additional file 5: Table S4. Gene expression array of PKH26+ versus PKH26− cells ordered accordin... more Additional file 5: Table S4. Gene expression array of PKH26+ versus PKH26− cells ordered according to PCA Factor 4 and transcripts modulated in quiescent/slow proliferating (PKH26+) and fast proliferating (PKH26−) cells.
Additional file 9: Figure S3. Trends of ZEB2 overexpression in cultured cells. a Percentage of GF... more Additional file 9: Figure S3. Trends of ZEB2 overexpression in cultured cells. a Percentage of GFP positivity in CCSCs (diamonds) or SW480 (circles) cells transduced with empty pLenti-GFP (Vector) or with pLenti-GFP-ZEB2 (ZEB2) as assessed by flow cytometry for 5 weeks following lentiviral transduction and sorting (day 0). Graph shows the mean ± SD of three independent experiments. b Representative confocal image of CCSCs and SW480 cells transduced with GFP-ZEB2 and labeled with anti-Ki67 at day 28 after sorting. Circles indicate rare ZEB2+ cells, which are also Ki67−. Scale bar, 50 μm.
Additional file 8: Figure S2. Expression of pCRAF in vivo and in vitro and complementary RPPA dat... more Additional file 8: Figure S2. Expression of pCRAF in vivo and in vitro and complementary RPPA data analysis. a Representative confocal microscopy images of PKH26-positive areas (yellow) in xenograft sections immunostained with anti-pCRAF S338 (green) and PROMININ1 (red). Scale bar, 80 μm. b Representative confocal microscopy images of SW480 cells treated for 48 h with 10 μM etoposide or 10 μM irinotecan and stained with anti-pCRAF S338 antibody. Scale bar, 20 μm. c Spatial representation of principal component (PC) analysis computed on a matrix having loading values of the two components, Factor 1 and Factor 2 that discriminates among PKH26+ and PKH26− samples. Results obtained on three PKH26+ versus PKH26− samples, n = 3 pools of 12 tumors each. d Spatial representation of scores of components representing relative RPPA antibodies values (Factor 1 and Factor 2). Results obtained on three PKH26+ versus PKH26− samples, n = 3 pools of 12 tumors each.
Additional file 10: Figure S4. In vivo effects of ZEB2 overexpression in CCSCs. a Volume of xenog... more Additional file 10: Figure S4. In vivo effects of ZEB2 overexpression in CCSCs. a Volume of xenografts derived from CCSCs transduced with pLenti-GFP (Vector, black line/triangles) or with pLenti-GFP-ZEB2 (ZEB2, red line/squares). Graph shows the mean ± SEM, 6 tumors/group. **P
Additional file 11: Figure S5. ZEB2 expression in TNM stages, correlation with RFS and CMS in sta... more Additional file 11: Figure S5. ZEB2 expression in TNM stages, correlation with RFS and CMS in stage 2 CRC patients. ZEB2 transcript levels in the indicated number of CRC patients across all TNM stages. One-way ANOVA resulted in non-significant differences between stages. Outliers are depicted as crosses. n = 1079.
Additional file 6: Table S5. Categories of transcripts expressed in PKH26-positive and PKH26-nega... more Additional file 6: Table S5. Categories of transcripts expressed in PKH26-positive and PKH26-negative cells.
Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is t... more Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the gold standard for curative treatment of peritoneal carcinomatosis (PC) arising from colorectal cancer, peritoneal mesothelioma and peritoneal pseudomyxoma peritonei (PMP). The results of HIPEC remain controversial in PC that originates from ovarian cancer, stomach cancer, neuroendocrine tumors, or sarcoma. HIPEC has also been used, although very rarely, for other malignant carcinomatoses. Its use has been exceptional due either to the rarity of the tumor or because such disease is usually widespread and rarely confined to the peritoneum. The aim of this study was to evaluate the results of CCRS plus HIPEC in patients with PC of unusual origin. We performed a retrospective analysis of all patients who underwent CCRS plus HIPEC for PC whose origin was neither gastric, ovarian or colorectal carcinoma, nor neuroendocrine tumor, mesothelioma, PMP or sarcoma. Between 1995 and 2013, 31 patie...
From its origins, abdominal surgery has benefited from the advantages of general anesthesia. At t... more From its origins, abdominal surgery has benefited from the advantages of general anesthesia. At the end of 20th century, regional anesthesia, as well as minimally invasive surgery, made a significant appearance. Thoracic neuraxial anesthesia has been used in major abdominal surgery and in oncology, on patients who, due to cardiorespiratory problems, could not undergo GA. Given the good results obtained, the method was also applied to patients in good conditions. CESA (combined epidural and spinal anesthesia) is emerging for minimally invasive surgery. Cases of open major abdominal surgery under neuraxial anesthesia have been collected in a few centers, but none of the series was laparoscopic. This article is a series of 84 patients undergoing abdominal surgery, partly for neoplasms, operated in laparoscopy and neuraxial anesthesia. Depending on the type of intervention, especially in the intra-abdominal operating region, the anesthetic techniques were different, spinal, epidural or ...
Background. Cystic echinococcosis (CE) is a chronic, clinically complex, and neglected disease. I... more Background. Cystic echinococcosis (CE) is a chronic, clinically complex, and neglected disease. Its prevalence in Italy, a country of medium to high endemicity, remains poorly defined, as notification has long ceased to be mandatory.Methods. We set up a retrospective cohort study involving all CE patients followed at our institute between January 2005 and December 2012. Demographical and clinical features were recorded and analyzed.Results. CE was found in 28 patients (64.3%), mostly Italians from the central regions (50%), followed by subjects from the islands (33.3%) and Southern Italy (16.7%). Their median age was 45 years (IQR: 38.5–66.5), with Eastern Europeans being significantly younger (28 years, IQR: 19–39) than other patients (P≤0.0001). A total of 149 cysts, mostly with hepatic localization (96%), were described. Based on the WHO classification, the cysts were mainly small (80.5%) and active (CE1 (73.8%); CE2 (7.4%)). Active cysts were more common in Eastern Europeans (85...
The aim of this study was to evaluate the accuracy of intra-operative ultrasound (IOUS) imaging i... more The aim of this study was to evaluate the accuracy of intra-operative ultrasound (IOUS) imaging in detecting liver secondaries at the time of primary colorectal surgery and to evaluate the impact of IOUS on patient management. Methods: Data from 167 patients with primary colorectal cancer who were admitted for elective surgery between January 1995 and December 2003 were prospectively evaluated and analysed. All patients underwent pre-operative abdominal ultrasonography (US) and computed tomography (CT), as well as IOUS. The final diagnosis of liver metastases was made by means of histological examination of either biopsy or surgical specimens. The sensitivities of preoperative US and CT were compared with the sensitivity of IOUS, referred to histology. Changes in surgical management owing to IOUS findings were noted. Results: IOUS supplied additional information in the case of 31 patients. In 28 of these patients, this information had a major impact on the intra-operative strategy, in that the procedure was altered. Conclusions: IOUS is safe, simple to perform and more accurate than pre-operative imaging. It reduces the number of patients subjected to superfluous surgery. The use of IOUS is therefore encouraged during colorectal cancer surgery.
Inferior vena cava (IVC) preservation during orthotopic liver transplantation (OLT) is known as t... more Inferior vena cava (IVC) preservation during orthotopic liver transplantation (OLT) is known as the &quot;piggyback&quot; technique. The end-to-side anastomosis is constructed between the graft&#39;s IVC and recipient&#39;s hepatic veins using a Satinsky side clamp applied in a transverse position. To stabilize the large Satinsky clamp and preserve a sufficient vascular stump after hepatectomy and before graft implantation, we propose a technical innovation consisting of hanging the septa between the left and middle hepatic vein and between the middle and right hepatic vein using 2 tapes. This technique showed some advantages when performing the caval outflow anastomosis, representing a further technical refinement of the piggyback end-to-side technique for the implantation on the 3 hepatic veins. From November 2001 to September 2012, we performed 272 consecutive OLT at our institution with the piggyback technique using the hanging of the hepatic veins septa in all cases. In conclusion, the hanging of the 3 hepatic veins septa presented in this study represents a simple, safe and reproducible technique for the outflow anastomosis using the piggyback technique.
Disponible sur Internet le 17 décembre 2015 MOTS CLÉS Carcinose péritonéale ; Tumeur rare ; Chimi... more Disponible sur Internet le 17 décembre 2015 MOTS CLÉS Carcinose péritonéale ; Tumeur rare ; Chimiohyperthermie intrapéritonéale ; Chirurgie Résumé Introduction.-Une chirurgie de cytoréduction complète (CCRC) plus chimiohyperthermie intrapéritonéale (CHIP) est le traitement curatif de référence des carcinoses péritonéales (CP) d'origine colorectale, des pseudomyxomes et des mésothéliomes péritonéaux. Ses résultats restent controversés dans les CP d'origine ovarienne, gastrique, neuroendocrine ou sarcomateuse. Ce traitement a aussi été utilisé de façon beaucoup plus inhabituelle dans d'autres pathologies, exceptionnelles en raison de leur rareté ou du caractère rarement isolé de la CP. Le but de ce travail était d'évaluer les résultats d'une CCRC plus CHIP chez les patients avec une CP inhabituelle. Méthodes.-Tous les patients traités par CCRC plus CHIP d'une CP non colorectale, non gastrique, non neuroendocrine, non pseudomyxome, non mésothéliome, non ovarienne et non sarcomateuse ont été rétrospectivement analysés. Résultats.-Entre 1995 et 2013, 31 patients ont été opérés pour une CP issue de 15 étiologies inhabituelles. Après un suivi médian de 90 mois, 10 patients étaient vivants et sans récidive. Le taux de survie globale à 5 ans était de 33 % et la survie médiane de 37 mois. En analyse univariée, les facteurs de mauvais pronostic et prédictifs de récidive étaient la réalisation d'une chimiothérapie intrapéritonéale postopératoire immédiate par rapport à une CHIP et un index péritonéal supérieur ou égal à 12. Aucun impact pronostique de l'origine tumorale n'a pu être démontré.
Background: Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treate... more Background: Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treated by surgical resection. The aim of this study was to evaluate the feasibility, morbidity and mortality of a laparoscopic approach in cirrhotic patients with HCC. Methods: From 2004 to September 2014, 90 patients underwent a laparoscopic liver resection (LLR) for HCC. Data were collected in a prospectively maintained database since 2001. Preoperative patient evaluation was based on a multidisciplinary team meeting assessment. Results: Median age was 63 years; 67 (74.4%) patients were male. Median body mass index (BMI) was 26.7. Underlying liver disease was known in 68 patients: in 46 patients' hepatitis C virus (HCV)-related, in 15 patients to hepatitis B virus (HBV)-related, in 5 patients alcohol-related. Child-Pugh Score was of grade A in 85 patients and of grade B in 5 patients; 63 patients had a Model for End-stage Liver Disease (MELD) <10 and 27 patients MELD >10. A total of 18 left lateral sectionectomies, 1 left hepatectomy and 71 wedge resections or segmentectomies were performed. Conversion to laparotomy was necessary in 7 (7.7%) patients (five cases for bleeding and two cases for oncological reasons). In 90 patients, 98 HCC nodules were resected: 79 patients had one nodule, 8 patients had two nodules and 1 patient had three nodules. HCC nodules medium diameter was 29 mm (range, 4-100 mm) with median value of 25 mm. Tumor margins distance was 16 mm (range, 0-35 mm) with a median of 5 mm. Seventy nodules were located within the anterior sectors and 28 nodules within the posterior sectors. Conclusions: LLR for HCC can be performed with acceptable morbidity in patients with underlying liver disease. The use of laparoscopic surgery in cirrhotic patients may be proposed as the first-line treatment for HCC or as bridge treatment before liver transplantation.
Metastasis is the primary cause of death in patients with colorectal cancer (CRC), urging the nee... more Metastasis is the primary cause of death in patients with colorectal cancer (CRC), urging the need for preclinical models that recapitulate the metastatic process at the individual patient level. We used an orthotopic patient-derived xenograft (PDX) obtained through the direct implantation of freshly dissociated CRC cells in the colon of immunocompromised mice to model the metastatic process. Ortho-PDX engraftment was associated to a specific set of molecular features of the parental tumor, such as epithelial-to-mesenchymal transition (EMT), TGF-β pathway activation, increased expression of stemness-associated factors and higher numbers of circulating tumor cells (CTCs) clusters expressing the metastatic marker CD44v6. A parallel analysis of orthotopic/metastatic xenografts and organoids showed that tumor cells underwent mesenchymal-to-epithelial transition at the metastatic site and that metastasis-derived organoids had increased chemotherapy resistance. These observations support ...
Additional file 5: Table S4. Gene expression array of PKH26+ versus PKH26− cells ordered accordin... more Additional file 5: Table S4. Gene expression array of PKH26+ versus PKH26− cells ordered according to PCA Factor 4 and transcripts modulated in quiescent/slow proliferating (PKH26+) and fast proliferating (PKH26−) cells.
Additional file 9: Figure S3. Trends of ZEB2 overexpression in cultured cells. a Percentage of GF... more Additional file 9: Figure S3. Trends of ZEB2 overexpression in cultured cells. a Percentage of GFP positivity in CCSCs (diamonds) or SW480 (circles) cells transduced with empty pLenti-GFP (Vector) or with pLenti-GFP-ZEB2 (ZEB2) as assessed by flow cytometry for 5 weeks following lentiviral transduction and sorting (day 0). Graph shows the mean ± SD of three independent experiments. b Representative confocal image of CCSCs and SW480 cells transduced with GFP-ZEB2 and labeled with anti-Ki67 at day 28 after sorting. Circles indicate rare ZEB2+ cells, which are also Ki67−. Scale bar, 50 μm.
Additional file 8: Figure S2. Expression of pCRAF in vivo and in vitro and complementary RPPA dat... more Additional file 8: Figure S2. Expression of pCRAF in vivo and in vitro and complementary RPPA data analysis. a Representative confocal microscopy images of PKH26-positive areas (yellow) in xenograft sections immunostained with anti-pCRAF S338 (green) and PROMININ1 (red). Scale bar, 80 μm. b Representative confocal microscopy images of SW480 cells treated for 48 h with 10 μM etoposide or 10 μM irinotecan and stained with anti-pCRAF S338 antibody. Scale bar, 20 μm. c Spatial representation of principal component (PC) analysis computed on a matrix having loading values of the two components, Factor 1 and Factor 2 that discriminates among PKH26+ and PKH26− samples. Results obtained on three PKH26+ versus PKH26− samples, n = 3 pools of 12 tumors each. d Spatial representation of scores of components representing relative RPPA antibodies values (Factor 1 and Factor 2). Results obtained on three PKH26+ versus PKH26− samples, n = 3 pools of 12 tumors each.
Additional file 10: Figure S4. In vivo effects of ZEB2 overexpression in CCSCs. a Volume of xenog... more Additional file 10: Figure S4. In vivo effects of ZEB2 overexpression in CCSCs. a Volume of xenografts derived from CCSCs transduced with pLenti-GFP (Vector, black line/triangles) or with pLenti-GFP-ZEB2 (ZEB2, red line/squares). Graph shows the mean ± SEM, 6 tumors/group. **P
Additional file 11: Figure S5. ZEB2 expression in TNM stages, correlation with RFS and CMS in sta... more Additional file 11: Figure S5. ZEB2 expression in TNM stages, correlation with RFS and CMS in stage 2 CRC patients. ZEB2 transcript levels in the indicated number of CRC patients across all TNM stages. One-way ANOVA resulted in non-significant differences between stages. Outliers are depicted as crosses. n = 1079.
Additional file 6: Table S5. Categories of transcripts expressed in PKH26-positive and PKH26-nega... more Additional file 6: Table S5. Categories of transcripts expressed in PKH26-positive and PKH26-negative cells.
Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is t... more Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the gold standard for curative treatment of peritoneal carcinomatosis (PC) arising from colorectal cancer, peritoneal mesothelioma and peritoneal pseudomyxoma peritonei (PMP). The results of HIPEC remain controversial in PC that originates from ovarian cancer, stomach cancer, neuroendocrine tumors, or sarcoma. HIPEC has also been used, although very rarely, for other malignant carcinomatoses. Its use has been exceptional due either to the rarity of the tumor or because such disease is usually widespread and rarely confined to the peritoneum. The aim of this study was to evaluate the results of CCRS plus HIPEC in patients with PC of unusual origin. We performed a retrospective analysis of all patients who underwent CCRS plus HIPEC for PC whose origin was neither gastric, ovarian or colorectal carcinoma, nor neuroendocrine tumor, mesothelioma, PMP or sarcoma. Between 1995 and 2013, 31 patie...
From its origins, abdominal surgery has benefited from the advantages of general anesthesia. At t... more From its origins, abdominal surgery has benefited from the advantages of general anesthesia. At the end of 20th century, regional anesthesia, as well as minimally invasive surgery, made a significant appearance. Thoracic neuraxial anesthesia has been used in major abdominal surgery and in oncology, on patients who, due to cardiorespiratory problems, could not undergo GA. Given the good results obtained, the method was also applied to patients in good conditions. CESA (combined epidural and spinal anesthesia) is emerging for minimally invasive surgery. Cases of open major abdominal surgery under neuraxial anesthesia have been collected in a few centers, but none of the series was laparoscopic. This article is a series of 84 patients undergoing abdominal surgery, partly for neoplasms, operated in laparoscopy and neuraxial anesthesia. Depending on the type of intervention, especially in the intra-abdominal operating region, the anesthetic techniques were different, spinal, epidural or ...
Background. Cystic echinococcosis (CE) is a chronic, clinically complex, and neglected disease. I... more Background. Cystic echinococcosis (CE) is a chronic, clinically complex, and neglected disease. Its prevalence in Italy, a country of medium to high endemicity, remains poorly defined, as notification has long ceased to be mandatory.Methods. We set up a retrospective cohort study involving all CE patients followed at our institute between January 2005 and December 2012. Demographical and clinical features were recorded and analyzed.Results. CE was found in 28 patients (64.3%), mostly Italians from the central regions (50%), followed by subjects from the islands (33.3%) and Southern Italy (16.7%). Their median age was 45 years (IQR: 38.5–66.5), with Eastern Europeans being significantly younger (28 years, IQR: 19–39) than other patients (P≤0.0001). A total of 149 cysts, mostly with hepatic localization (96%), were described. Based on the WHO classification, the cysts were mainly small (80.5%) and active (CE1 (73.8%); CE2 (7.4%)). Active cysts were more common in Eastern Europeans (85...
The aim of this study was to evaluate the accuracy of intra-operative ultrasound (IOUS) imaging i... more The aim of this study was to evaluate the accuracy of intra-operative ultrasound (IOUS) imaging in detecting liver secondaries at the time of primary colorectal surgery and to evaluate the impact of IOUS on patient management. Methods: Data from 167 patients with primary colorectal cancer who were admitted for elective surgery between January 1995 and December 2003 were prospectively evaluated and analysed. All patients underwent pre-operative abdominal ultrasonography (US) and computed tomography (CT), as well as IOUS. The final diagnosis of liver metastases was made by means of histological examination of either biopsy or surgical specimens. The sensitivities of preoperative US and CT were compared with the sensitivity of IOUS, referred to histology. Changes in surgical management owing to IOUS findings were noted. Results: IOUS supplied additional information in the case of 31 patients. In 28 of these patients, this information had a major impact on the intra-operative strategy, in that the procedure was altered. Conclusions: IOUS is safe, simple to perform and more accurate than pre-operative imaging. It reduces the number of patients subjected to superfluous surgery. The use of IOUS is therefore encouraged during colorectal cancer surgery.
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