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Thomas Gruenberger, MD; Jean-Luc Jourdan, MD; Jing Zhao, MMs; Julie King, MPH; David Lawson Morris, MD, PhD

Arch Surg. 2000;135:1285-1290.

Hypothesis  Intraoperative echogenic appearance of liver metastases from colorectal cancer is a prognostic factor of outcome after curative treatment.

Design  Retrospective analysis of prospectively collected data.

Setting  Department of Surgery at a university hospital.

Patients  One hundred forty-three consecutive patients with hepatic metastases from colorectal cancer who underwent liver resection with curative intent between 1992 and 1998.

Intervention  Curative treatment was achieved by liver resection alone, liver resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 lesions, a hepatic artery catheter was placed for regional chemotherapy.

Main Outcome Measures  The echogenic appearance of the liver metastases was assessed by intraoperative ultrasound by a single person throughout the study using a 5-MHz ultrasound probe. The findings were prospectively entered into the database.

Results  Fifty-four percent of patients had hyperechoic metastases. This group had significantly longer overall (log rank, P<.001) and recurrence-free survival (log rank, P = .004) compared with patients who had hypoechoic metastases (36%). A significantly higher percentage of mucin-secreting tumors were found in the hypoechoic patient group (², P = .001). Dukes stage of the primary tumor (P = .02), echogenicity of the liver secondaries (P = .04), and diameter of the largest resected metastasis (P = .01) were independent prognostic factors for recurrence-free survival in the Cox regression model.

Conclusion  These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of outcome after curative resection.

From the Department of Surgery, University of New South Wales, St George Hospital, Kogarah, Sydney, Australia.

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