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Improved selection of patients for hepatic surgery of colorectal liver metastases with FDG-PET: A randomized study

¹ Nuclear Medicine; ² Surgery, Radboud University Nijmegen Medical Ctr, Nijmegen, Netherlands; ³ Surgery, VUmc, Amsterdam, Netherlands; ⁴ Surgery, MMC, Veldhoven, Netherlands; ⁵ Surgery, UMC Groningen, Groningen, Netherlands; ⁶ Nuclear Medicine, VUmc, Amsterdam, Netherlands; ⁷ Nuclear Medicine & Molecular Imaging, UMC Groningen, Groningen, Netherlands; ⁸ Radiology; ⁹ MTA, Radboud University Nijmegen Medical Ctr, Nijmegen, Netherlands

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Objectives: Careful selection of patients who may benefit from surgical treatment of colorectal liver metastases is critical. Staging by PET with FDG is thought to be better than CT staging alone. Evidence that the addition of FDG-PET leads to superior clinical results and improved clinical management in these patients are lacking. In this randomised controlled trial, we investigated whether the addition of FDG-PET is beneficial and reduces the number of futile laparotomies.

Methods: 150 patients with colorectal liver metastases selected for surgical treatment by imaging with CT scan were randomly assigned to CT imaging only (n=75) or CT imaging plus FDG-PET (n=75). Primary outcome measure was futile laparotomy, defined as any laparotomy that did not result in complete tumour treatment, that revealed benign disease or that did not result in a disease free survival period longer than 6 months.

Results: Clinical characteristics were similar for both groups. The number of futile laparotomies was 34 (45%) in the group without PET and 21 (28%) in the group with PET, the relative risk reduction was 38% (95%CI = 4%-60%).

Conclusions: Addition of FDG- PET to the work-up for surgical resection of colorectal liver metastases prevents unnecessary surgery in one out of six patients.

Research Support: Supported by ZonMW (DO 2001 #945-10-017)

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Oyen, W. Articles by Ruers, T. PubMed Articles by Oyen, W. Articles by Ruers, T.