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How to operate a liver tumor you cannot see

: Oldhafer, K.J.; Stavrou, G.A.; Prause, G.; Peitgen, H.-O.; Lueth, T.C.; Weber, S.


Langenbeck's archives of surgery 394 (2009), Nr.3, S.489-494
ISSN: 1435-2443
ISSN: 1435-2451
Fraunhofer MEVIS ()
colorectal neoplasm; pathology; computer peripheral; human; liver neoplasm; secondary; surgery; ultrasonography; male; middle aged; optical device; risk assessment; stereotaxic technique; Computer-Assisted instrumentation; tomography; x-ray computed

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.