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Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study

¹ Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; ² Department of Surgical Oncology, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands; ³ Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands; ⁴ Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation at the University Medical Center Groningen, Groningen, The Netherlands; ⁵ Department of Nuclear Medicine and PET Research, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands; ⁶ Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands; ⁷ Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; ⁸ Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and ⁹ Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Correspondence: For correspondence or reprints contact: Wim J.G. Oyen, Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: w.oyen{at}nucmed.umcn.nl

With the increasing possibilities for surgical treatment of colorectal liver metastases, careful selection of patients who may benefit from surgical treatment becomes critical. The addition of PET to ¹⁸F-FDG may significantly improve conventional staging by CT. Up to now, definitive evidence that the addition of ¹⁸F-FDG PET to conventional staging leads to superior clinical results and improved clinical management in these patients has been lacking. In this randomized controlled trial in patients with colorectal liver metastases, we investigated whether the addition of ¹⁸F-FDG PET is beneficial and reduces the number of futile laparotomies. Methods: A total of 150 patients with colorectal liver metastases selected for surgical treatment by imaging with CT were randomly assigned to CT only (n = 75) or CT plus ¹⁸F-FDG PET (n = 75). Patients were followed up for at least 3 y. The primary outcome measure was futile laparotomy, defined as any laparotomy that did not result in complete tumor treatment, that revealed benign disease, or that did not result in a disease-free survival period longer than 6 mo. Results: Patient and tumor characteristics were similar for both groups. The number of futile laparotomies was 34 (45%) in the control arm without ¹⁸F-FDG PET and 21 (28%) in the experimental arm with ¹⁸F-FDG PET; the relative risk reduction was 38% (95% confidence interval, 4%–60%, P = 0.042). Conclusion: The number of futile laparotomies was reduced from 45% to 28%; thus, the addition of ¹⁸F-FDG PET to the work-up for surgical resection of colorectal liver metastases prevents unnecessary surgery in 1 of 6 patients.

Key Words: colorectal cancer • ¹⁸F-FDG-PET • liver metastases • staging • surgery

^* Contributed equally to this work.

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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