1005 Novel method for detecting liver metastases

Abstract

All patients undergoing curative surgery for colorectal cancer should have an accurate staging of their liver prior to treatment. However, conventional radiological methods which rely on the differences of density of neoplastic tissue and normal liver have limits in their resolution rarely detecting lesions less than 1 cm in diameter. An alternative approach is to measure functional changes in the liver that result from the development of liver metastases. Over the last nine years, in a series of animal and clinical experiments, we have demonstrated that the presence of tumour within the liver causes changes in the hepatohaemodynamics with alterations both in hepatic arterial and portal flow. These changes appear to be the result of the release of a vasoactive agent although this has not yet been identified. In patients hepatic and portal venous inflow can be measured indirectly using scintographic methods or more recently by direct measurements using colour Doppler flowmetry. Using both of these techniques, we are able to predict the development of liver metastases in patients undergoing curative colorectal surgery who have no metastases apparent at the time of surgery assessed by either computerised tomography or ultrasound techniques. These measurements independently predict prognosis for a patient and may be useful in selecting high risk cases for adjuvant chemotherapy.