PREOPERATIVE EVALUATION OF PATIENTS FOR LIVER RESECTION - APPROPRIATE CT IMAGING

Objective The authors determined which combination of computed tomography scans is most helpful for preoperative assessment of patients with liver tumors. Summary Background Data Multi-institutional studies have shown that the most important prognostic factors for selection of patients with metastatic colorectal cancer considered for liver resection are: Dukes' stage of primary tumor, the number of hepatic metastases if greater than 3, the presence of extrahepatic cancer, and the ability to resect tumors with an adequate margin (> 1 cm.) Therefore the ability to predict the presence of extrahepatic disease and the number and location of hepatic tumors are important in these patients. Methods One hundred and nine consecutive patients with evidence of hepatic tumors were evaluated by computed tomography with arterial portography (CTAP) and abdominal computed tomography after a 4-hour delay (CT-D). Results of these studies and conventional computed tomography (CT-C) were compared with findings at operation. Results CTAP proved to be the most sensitive test for assessing distribution of intrahepatic disease. CT-D was no more sensitive than CT-C for the detection of hepatic or extrahepatic disease. Conclusions CT-C in concert with CTAP provides the most reasonable CT evaluation of patients considered for operation for the treatment of hepatic tumors.