| Abstract: | Purpose Pre‐operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo‐adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre‐op planning tools. Methodology All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo‐adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra‐op ultrasound/examination. Accurate scans (scan lesions = true lesions), over‐estimations (scan lesions > true lesions) and under‐estimations (scan lesions < true lesions) were recorded. Results 25 patients had pre‐op CT portography with neo‐adjuvant chemo and 63 without. Accurate scans on a per‐patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non‐chemo group, p < 0.002. Notably, there were 17 (68%) over‐estimates in the chemo group vs. 25 (40%) in the non‐chemo group. There were 6 (24%) vs. 11 (17%) under‐estimates respectively. 23 patients had pre‐op helical CT with neo‐adjuvant chemo and 64 without. Accurate scans on a per‐patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non‐chemo group, p = 0.388. There were 8 (35%) over‐estimates in the chemo group vs. 12 (19%) in the non‐chemo group. There were 8 (35%) vs. 26 (41%) under‐estimates respectively. Conclusion While CT portography is useful for detecting occult hepatic metastases, there is evidence that over‐estimation of disease is a problem, particularly when neo‐adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent. |
