Colorectal cancer is currently one of the most common digestive system tumors, and the liver is the most common metastatic site of colorectal cancer. In recent years, with the continuous development of the multidisciplinary treatment for colorectal cancer patients, there are quite a few cases of disappearing liver metastases (DLM) after receiving preoperative chemotherapy (or combined targeted drug therapy), and the diagnosis and treatment of DLM is currently still a very challenging and controversial topic. This article sorts out the related researches on DLM in recent years, mainly including the following 4 aspects: (1) The factors associated with DLM, including the size and number of liver metastases, chemotherapy regimens and cycles, targeted therapy drugs, and the pattern of liver metastases, Ras/Braf status and the location of the primary lesion. (2) The relationship between DLM and true complete response (pathological complete response and persistent clinical complete response), and the related predictive factors of pathological complete response. (3) Clinical evaluation of DLM: preoperative evaluation includes ultrasound, CT, MRI, and PET, while intraoperative evaluation includes intraoperative exploration, intraoperative ultrasound, and augmented reality. (4) DLM treatment strategies, including surgical treatment, local treatment, non-surgical treatment and individualized treatment.
Colorectal Neoplasms ; Humans ; Liver Neoplasms ; Magnetic Resonance Imaging ; Ultrasonography

Pancreatic cancer (PC) is the third most common cause of cancer-related death in the United States and the 12th most common worldwide. Mortality is high, largely due to late stage of presentation and suboptimal treatment regimens. Approximately 10% of PC cases have a familial basis. The major genetic defect has yet to be identified but may be inherited by an autosomal dominant pattern with reduced penetrance. Several known hereditary syndromes or genes are associated with an increased risk of developing PC and account for approximately 2% of PCs. These syndromes include the hereditary breast-ovarian cancer syndrome, Peutz-Jeghers syndrome, familial atypical multiple mole melanoma, Lynch syndrome, familial polyposis, ataxia-telangiectasia, and hereditary pancreatitis. Appropriate screening using methods such as biomarkers or imaging, with endoscopic ultrasound and magnetic resonance imaging, may assist in the early detection of neoplastic lesions in the high-risk population. If these lesions are detected and treated before the development of invasive carcinoma, PC disease morbidity and mortality may be improved. This review will focus on familial PC and other hereditary syndromes implicated in the increased risk of PC; it will also highlight current screening methods and the future of new screening modalities.
Ataxia Telangiectasia ; Biomarkers ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Dysplastic Nevus Syndrome ; Magnetic Resonance Imaging ; Mass Screening* ; Mortality ; Pancreatic Neoplasms* ; Pancreatitis ; Penetrance ; Peutz-Jeghers Syndrome ; Ultrasonography ; United States

PURPOSE: Pharmacologic thromboprophylaxis is routinely recommended for Western cancer patients undergoing major surgery for prevention of venous thromboembolism (VTE). However, it is uncertainwhetherroutine administration of pharmacologic thromboprophylaxis is necessary in all Asian surgical cancer patients. This prospective study was conducted to examine the incidence of and risk factors for postoperative VTE in Korean colorectal cancer (CRC) patients undergoing major abdominal surgery. MATERIALS AND METHODS: This study comprised two cohorts, and none of patients received perioperative pharmacologic thromboprophylaxis. In cohort A (n=400), patients were routinely screened for VTE using lower-extremity Doppler ultrasonography (DUS) on postoperative days 5-14. In cohort B (n=148), routine DUS was not performed, and imaging was only performed when there were symptoms or signs that were suspicious for VTE. The primary endpoint was the VTE incidence at 4 weeks postoperatively in cohort A. RESULTS: The postoperative incidence of VTE was 3.0% (n=12) in cohort A. Among the 12 patients, eight had distal calf vein thromboses and one had symptomatic thrombosis. Age ≥ 70 years (odds ratio [OR], 5.61), ≥ 2 comorbidities (OR, 13.42), and white blood cell counts of > 10,000/μL (OR, 17.43) were independent risk factors for postoperative VTE (p < 0.05). In cohort B, there was one case of VTE (0.7%). CONCLUSION: The postoperative incidence of VTE, which included asymptomatic cases, was 3.0% in Korean CRC patients who did not receive pharmacologic thromboprophylaxis. Perioperative pharmacologic thromboprophylaxis should be administered to Asian CRC patients on a risk-stratified basis.
Asia ; Asian Continental Ancestry Group ; Cohort Studies ; Colorectal Neoplasms* ; Colorectal Surgery ; Comorbidity ; Humans ; Incidence* ; Leukocyte Count ; Prospective Studies* ; Risk Factors ; Thrombosis ; Ultrasonography, Doppler ; Veins ; Venous Thromboembolism*

The use of gas-filled microbubbles in perfusion monitoring as intravascular ultrasound contrast agents has recently become more common. Additionally, microbubbles are employed as carriers of pharmaceutical substances or genes. Microbubbles have great potential to improve the delivery of therapeutic materials into cells and to modify vascular permeability, causing increased extravasation of drugs and drug carriers. Prostate cancer is the most common neoplasm in Europe and America, with an incidence twice to three times that of lung and colorectal cancer. Its incidence is still rising in Asian countries, including Japan and Korea. In this review, we present current strategies regarding the synthesis of microbubbles with targeted ligands on their surfaces, with a focus on prostate cancer.
Americas ; Asian Continental Ancestry Group ; Capillary Permeability ; Colorectal Neoplasms ; Contrast Media ; Drug Carriers ; Europe ; Humans ; Incidence ; Japan ; Korea ; Ligands ; Lung ; Microbubbles* ; Perfusion ; Prostate* ; Prostatic Neoplasms* ; Ultrasonography*

BACKGROUND/AIMS: Gallbladder polyps and colorectal adenomas share many common risk factors; however, their association has never been studied. The aim of this study was to investigate this association in asymptomatic healthy subjects. METHODS: Consecutive asymptomatic subjects who underwent both screening colonoscopy and abdominal ultrasonography at Kyung Hee University Hospital in Gang Dong between July 2010 and April 2011 were prospectively enrolled. The prevalence of colorectal adenoma was compared between subjects with or without gallbladder polyps. Furthermore, a logistic regression analysis was performed to determine the independent risk factors for colorectal adenoma in these subjects. RESULTS: Of the 581 participants, 55 presented with gallbladder polyps and 526 did not have gallbladder polyps. Participants with gallbladder polyps showed a trend toward a higher prevalence of colorectal adenoma than those without gallbladder polyps (52.7% vs. 39.2%, P=0.051). Although the result was not statistically significant, gallbladder polyps were found to be a possible risk factor for colorectal adenoma (odds ratio=1.796, 95% confidence interval=0.986-3.269, P=0.055), even after adjusting for potential confounding factors. There was no difference observed in colorectal adenoma characteristics between the two groups. CONCLUSIONS: Our results suggest a possible association between gallbladder polyps and colorectal adenomas. Future studies with larger cohorts are warranted to further investigate this matter.
Adenoma* ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms ; Gallbladder* ; Logistic Models ; Mass Screening ; Polyps* ; Prevalence ; Prospective Studies ; Risk Factors ; Ultrasonography

Adenomatous Polyps ; diagnostic imaging ; etiology ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; diagnostic imaging ; etiology ; Female ; Humans ; Liver ; diagnostic imaging ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; complications ; diagnostic imaging ; Ultrasonography

PURPOSE: The aim of this study was to evaluate the tissue stiffness of solid pancreatic lesions by using acoustic radiation force impulse (ARFI) elastography to differentiate benign from malignant pancreatic lesions. METHODS: ARFI elastography was performed in 26 patients who had 27 focal solid pancreatic lesions, including 8 benign lesions (mass-forming pancreatitis, 5; autoimmune pancreatitis, 3) and 19 malignant lesions (pancreatic adenocarcinoma, 16; metastasis from colorectal cancer, 2; malignant neuroendocrine tumor, 1). On the elastographic images of virtual touch tissue imaging (VTI), the echogenicity of the mass was categorized on a 5-grade scale. On the elastographic image of virtual touch tissue quantification (VTQ), the shear wave velocities (SWVs) of the lesion and surrounding parenchyma were measured. RESULTS: On the VTI images, the mean echogenicity score of the malignant lesions (3.7+/-1.0) was higher than that of the benign lesions (3.1+/-0.4; P=0.023). On the VTQ images, there were no statistical differences in the mean SWV between the benign (2.4+/-1.1 m/sec) and malignant (3.3+/-1.0 m/sec) lesions (P=0.101). However, the mean SWV difference values between the lesion and background parenchyma of the malignant lesions (1.5+/-0.8 m/sec) were higher than those of the benign lesions (0.4+/-0.3 m/sec; P=0.011). CONCLUSION: ARFI elastography can determine the relative stiffness between a lesion and the background pancreatic parenchyma using VTI and VTQ, which is helpful in the differentiation between benign and malignant solid pancreatic lesions.
Acoustics* ; Adenocarcinoma ; Colorectal Neoplasms ; Diagnosis, Differential* ; Elasticity Imaging Techniques* ; Humans ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreas ; Pancreatic Neoplasms ; Pancreatitis ; Ultrasonography

BACKGROUND AND OBJECTIVEPercutaneous ultrasound-guided thermal ablation is one of the major treatment methods for liver cancer. Tumor location close to the diaphragm or gastrointestinal tract was regarded as the treatment contraindication before due to poor visibility of the tumor or increased risk of thermal injury to the adjacent organs. This study used artificial pleural effusion or ascites to extend the indications of thermal ablation for liver cancer.

METHODSArtificial pleural effusion (20 cases) or ascites (36 cases) was performed in 56 difficult cases of percutaneous thermal ablation for liver tumors. The technical success rates, the rate of approaching the procedure goal, complications, and local treatment response were assessed.

RESULTSThe technical success rates were 95% (19/20) for artificial pleural effusion and 100% (36/36) for artificial ascites, the achieve purpose rates were 100% (19/19) and 91.7% (33/36), the complete ablation rates were 84.2% (16/19) and 93.9% (31/33), respectively. Coughing, transient hematuria, and subcutaneous effusion were observed in 3 patients after the procedure of artificial pleural effusion, and hydrothorax in the right chest occurred in 1 patient during the artificial ascites process.

CONCLUSIONSThermal ablation with the use of artificial pleural effusion or ascites is a safe and effective treatment for liver tumors, and the technique can widen the indications of thermal ablation for liver tumors.

Adult ; Aged ; Aged, 80 and over ; Ascites ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; secondary ; surgery ; Catheter Ablation ; adverse effects ; methods ; Colorectal Neoplasms ; pathology ; Cough ; etiology ; Female ; Glucose ; administration & dosage ; Hematuria ; etiology ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Male ; Microwaves ; Middle Aged ; Pleural Effusion ; Ultrasonography, Interventional ; Young Adult

OBJECTIVETo evaluate the diagnostic value of multislice spiral CT (MSCT) pneumocolon and image reconstruction in colorectal carcinomas.

METHODS206 patients with suspected colorectal cancer underwent whole abdominal fast volume scan using 16-slice spiral CT before they were insufflated with 1000-1500 ml air through the anus. Then the axis data were transferred to workstation for imaging by MPR, SSD, Raysum, MIP and CTVE, respectively. The results of MSCT diagnosis were compared with those of surgical pathology and from some other common adjunctive techniques, such as ultrasonography (US), colonoscopy (CC), and etc.

RESULTSIn this group, 192 cases were confirmed to be colorectal cancer by surgical pathology. 189 cases were identified by MSCT. The sensitivity, specificity and accuracy was 98.4%, 92.8% and 98.1%, respectively. The accuracy rate of general tumor classification was 98.4%. These data were compared with those by US and CC, Statistical analysis showed that the qualitative diagnosis of MSCT is more accurate than those of other two examination methods, indicating that it is most valuable clinical detection approach at present.

CONCLUSIONMSCT pneumocolon is a superior detecting method as it is safe, quick and accurate. Due to the accuracy in orienting and qualitative diagnosis by comprehensive application of 2D and 3D imaging techniques, it can clearly display the detailed information of tumor in terms of morphological characteristics, blood-supply resources and pericolonic lymph nodes involvement, which provides reliable basis for making rational surgical protocol.

Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods ; Male ; Middle Aged ; Sensitivity and Specificity ; Tomography, Spiral Computed ; methods ; Ultrasonography ; Young Adult

The optimal management of hepatic metastases in colorectal carcinoma patients has become increasingly complex with the myriad of available treatment options. Because the timing of any therapy has become integral to the success of the treatment, a collaborative approach involving multiple specialties is needed for achieving the best patient outcome. Surgical resection is the most effective therapy for metastatic colorectal cancer isolated to the liver. Liver resection of colorectal metastases is associated with three- and five-year survival rates close to 40~60% and 30~50%, respectively. Because the technique for hepatic resection has improved, patients with multiple, biloba, and huge metastases can undergo resection. Every liver resection should be planned after intraoperative ultrasonography, and an anatomical surgical procedure should be preferred instead of wedge resection. Since some of patients diagnosed with metastatic colorectal disease are initially classified as unresectable, neoadjuvant chemotherapy is being increasingly employed to downsize colorectal metastasis. The greatest benefit of the preoperative approach is the potential to convert patients with initially unresectable metastatic disease to a resectable state. Although various prognostic risk factors have been identified, there has been no dependable staging or prognostic scoring system for metastatic hepatic tumor. As surgeons become more proficient in the technical aspects of resection, the patient selection criteria as based on the biologic determinants of the outcome are becoming increasingly important. The goal of this review is to provide the optimal management, treatment and follow-up for patients with colorectal metastasis to the liver.
Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver* ; Neoplasm Metastasis* ; Patient Selection ; Risk Factors ; Survival Rate ; Ultrasonography