Preoperative Marking of a Tiny Lesion after Chemotherapy for Colorectal Liver Metastasis—Report of a Case—

Abstract

Preoperative chemotherapy has been established as a therapy for liver metastases of colorectal cancer and is now widely used. One concern is that the lesions sometimes disappear or become too small to recognize at the time of hepatectomy. A preoperative method of marking such a small liver metastasis is described.

A 57-year-old patient was diagnosed with rectal cancer and underwent preoperative chemoradiotherapy. Since magnetic resonance imaging (MRI) after chemoradiotherapy showed an increased number of liver metastases, XELOX+Bmab was given for 6 cycles instead of planned surgery. On MRI performed after chemotherapy, a remarkable response was seen, and the S4 tumor could only be faintly identified, not being recognizable on abdominal ultrasonography. It was decided to perform preoperative coiling. On the day before surgery, marking was performed under computed tomography (CT) guidance with reference to MRI. Intraoperative ultrasonography showed that the highly echoic part of the nearby Glisson's structure was confused with the marker, but the marker was finally identified, and the tumor was resected.

Preoperative marking was considered effective to facilitate removal of small hepatic metastasis, but it was considered necessary to select a material that can be more clearly distinguished by intraoperative ultrasound.