Six of the Best, Colorectal 20

Abstract

Aims: Surgical resection is the only potential cure for patients with colorectal liver metastases (CLM), but patient selection relies on accurate preoperative staging. The aim of this study was to assess the accuracy of routinely using whole-body FDG-PET (WBPET) for preoperative staging of patients being considered for resection of CLM. Methods: A prospective study of patients referred for possible hepatic resection was undertaken. Patients were initially staged by spiral CT and subsequently underwent WBPET. These modalities were considered independently before findings were compared and a decision regarding patient management was made. Accuracy of each modality was compared with histology, clinical/radiological follow-up or operative findings if appropriate. Results: Twenty-nine patients were recruited. Ten solitary CLM were correctly identified by both WBPET and CT. Nineteen patients had multiple CLM or extrahepatic disease, of these CT correctly staged seven patients (36 per cent), understaged 10 patients (53 per cent) and overstaged two (11 per cent). WBPET correctly staged 18 patients (95 per cent) and overstaged just one (5 per cent). WBPET was more sensitive and specific (100 and 92 per cent, respectively) for detecting multiple CLM and extrahepatic disease compared to CT (41 and 83 per cent). As a result of routine WBPET, patient management was altered in 10 patients (34 per cent), of whom four (14 per cent) avoided inappropriate surgery. Conclusions: WBPET is both more sensitive and specific in the preoperative staging of CLM, and we recommend its inclusion in the management algorithm of all patients being considered for hepatic resection. Altered patient management such as avoiding inappropriate laparotomy may also ultimately lead to financial savings.