Ann Surg 2001 Mar;233(3):293-9
Survival of patients evaluated by FDG-PET before hepatic resection for
metastatic colorectal carcinoma: a prospective database study.
Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D.
OBJECTIVE: To present the survival results for patients with colorectal
carcinoma metastases who have undergone liver resection after being staged by
[(18)F] fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET). SUMMARY
BACKGROUND DATA: Hepatic resection is standard therapy for colorectal metastases
confined to the liver, but recurrence is common because of the presence of
undetected cancer at the time of surgery. FDG-PET is a sensitive diagnostic tool
that identifies tumors based on the increased uptake of glucose by tumor cells.
To date, no survival results have been reported for patients who have actually
had liver resection after being staged by FDG-PET. METHODS: Forty-three patients
with metastatic colorectal cancer were referred for hepatic resection after
conventional tumor staging with computed tomography. FDG-PET was performed on
all patients. Laparotomy was performed on patients not staged out by PET.
Resection was performed at the time of laparotomy unless extrahepatic disease or
unresectable hepatic tumors were found. Patients were examined at intervals in
the preoperative period. RESULTS: FDG-PET identified additional cancer not seen
on computed tomography in 10 patients. Surgery was contraindicated in six of
these patients because of the findings on FDG-PET. Laparotomy was performed in
37 patients. In all but two, liver resection was performed. Median follow-up in
the 35 patients undergoing resection was 24 months. The Kaplan-Meier estimate of
overall survival at 3 years was 77% and the lower 95% confidence limit of this
estimate of survival was 60%. This figure is higher than 3-year estimate of
survival found in previously published series. The 3-year disease-free survival
rate was 40%. CONCLUSIONS: Preoperative FDG-PET lessens the recurrence rate in
patients undergoing hepatic resection for colorectal metastases to the liver by
detection of disease not found on conventional imaging.
