How to operate a liver tumour you cannot see

Oldhafer, KJ; Stavrou, GA; Prause, G; Peitgen, HO; Lueth, TC; Weber, S (2009). How to operate a liver tumour you cannot see. Langenbeck's archives of surgery, 3(394), pp. 489-494. Berlin: Springer 10.1007/s00423-009-0469-9

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Backround
As recent chemotherapy regimens for metastatic colorectal cancer become more and more effective in a neoadjuvant setting before liver surgery, a “complete” clinical response is sometimes documented on imaging. Without operation though, metastatic recurrence is likely to commence within 12 months. Surgeons now face the problem to resect non-visualizable and non-palpable lesions.

Methods
Computer-based virtual surgery planning can be used to fuse pre- and postchemotherapy computed tomography data to develop an operative strategy. This information is then intraoperatively transferred to the liver surface using an image-guided stereotactically navigated ultrasound dissector. This enables the surgeon to perform a resection that is otherwise not possible.

Results
During operation, detection of the lesion through palpation or ultrasound was impossible. After registering the virtual operation plan into the navigation system, the planned resection was performed without problems. Histopathologic workup showed vital tumor cells in the specimen.

Conclusion
The new image-guided stereotactic navigation technique combined with virtual surgery planning can solve the surgeon’s dilemma and yield a successful operation.

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