Intraoperative laparoscopic ultrasound-guided resection and microwave ablation for colorectal liver metastases

BACKGROUND Colorectal cancer (CRC) frequently metastasizes to the liver, significantly compromising patient survival. While surgical resection improves outcomes for resectable cases, many patients have limited therapeutic options. AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases (CRLM). METHODS Between June 2018 and June 2020, 300 patients with CRC and liver metastases were admitted to our hospital. They were divided into two groups (150 cases each) based on treatment method: The control group (ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging) and the observation group contrast-enhanced ultrasound with Sonazoid (S-CEUS). RESULTS The study group demonstrated better efficacy (P < 0.05), fewer adverse events (P < 0.05), and better survival outcomes compared to the control group (1-year: 80% vs 62%; 3-year: 54% vs 33%; 5-year: 32% vs 18%; median survival: 48 months vs 30 months; hazard ratio = 0.63, 95%CI: 0.48-0.83, P < 0.001). Although Karnofsky Performance Status scores improved in both groups, the scores were significantly higher in the observation group (P < 0.05). Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors (P < 0.05). CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM, reducing complications and enhancing survival. Intraoperative S-CEUS was an independent prognostic factor, supporting its clinical value.