Surgery to remove liver metastases has become more common and more aggressive in recent years. Even when liver metastases are present at diagnosis, surgeons are eager to remove them despite the ominous prognosis. Is there a reason to put on the brakes to all of this? A recent article in The Lancet Oncology investigators have examined the role of more careful pre-operative screening before launching into surgery on the liver. They identified about 300 patients who were candidates for liver surgery, either at the time the colon cancer was discovered or months to years afterwards. The patients typically had only a few metastases at most and were considered by CT scan resectable for cure. The patients underwent MRI of the liver with gadoxetic acid, a contrast dye that is specific to the liver. So what did they find?
Fully 31% of patients had their therapy altered based on the MRI findings. 13% of the patients needed more surgery than was originally planned, 11% needed less. 11% had their surgery cancelled altogether because new lesions were found that made the patients incurable. 3% had their diagnosis changed and were felt not to have metastases at all.
At the time of surgery almost all of the patients had intra-operative ultrasound as well. A small number of them had additional metastases found not otherwise appreciated pre-operatively. Most of these patients had additional resection performed on the spot.
So…the take home message is to do extra evaluation before jumping into surgery. The desire to do everything possible for patients with cancer in overwhelming, but doing foolish things won’t help. As better imaging techniques are invented, this field will continue to change, likely for the better.