IMPROVING TUMOUR DETECTION

The two researchers undertook a clinical research project aimed at evaluating the relevance of using ultrasound on the liver during surgery as a means of tumour detection. The results were unequivocal: in 10% of cases ultrasound detected tumours that had gone unnoticed by magnetic resonance imaging. More importantly, in 16% of cases the liver resection was altered in light of this new data. The removal of the additional tumours found by ultrasound considerably improves the survival rate of patients. As Dr Vandenbroucke-Menu notes, “using ultrasound make it possible for us not only to discover additional tumours, but also to see that the targeted tumour is closer to blood vessels than preoperative imaging had led us to believe and to modify the planned surgical intervention accordingly. This makes it an extremely important tool for liver surgery.”

This soon-to-be-published study is the most important to date given that its conclusions are based on observations of 400 patients at the University of Montreal Hospital Centre (CHUM). A cohort of this size lends considerable weight to the study’s findings. “Most publications on this subject,” explains Dr Lapointe, “focus more on the number of tumours and have many fewer patients.”deux chercheurs ont collaboré sur un projet de recherche évaluant la pertinence de l’échographie effectuée directement sur le foie durant la chirurgie comme outil de détection de tumeurs.   

PREOPERATIVE 3D SIMULATIONS

Another important aspect of liver resection involves ensuring that the patient is left with enough of his or her liver following the operation. Lapointe and Vandenbroucke-Menu  conducted a study in collaboration with the IRCAD (Institut de Recherche contre les Cancers de l’Appareil Digestif) in France to validate a new 3D imaging technology that evaluates the total volume of the tumours and the remaining liver. The idea was to simulate the liver resection using a 3D reconstruction of the patient’s liver,tumours and blood vessels and to determine the volume of the remaining liver. This study was the first of its kind to compare this technology to the manual measures obtained by radiology. The results demonstrated that the two techniques are practically equivalent to one another. For Dr Vandenbroucke-Menu, the new technique is promising: “a 3D image provides a better representation of what the surgeon finds in the operating room.”

TRANSLATIONAL RESEARCH

Since 2010, Dr Lapointe and Dr Vandenbroucke-Menu have been developing a human tissue
bank with samples from patients with liver or pancreatic cancer. At the same time, they have been working on a clinical data bank containing patient information that will make it possible to consolidate the work of basic scientists and clinicians in a single data bank. Indeed, one the difficulties faced by basic scientists is that of correlating their findings with clinical data. With this biobank, establishing a link between patients and tissues will be easier, will happen more quickly, and will improve both early liver cancer detection and its treatment. Moreover, it should also contribute to research into new treatments for pancreatic cancer through work on tumour infiltrating lymphocytes and thereby improve the possibilities for the development of vaccine therapies or for the injection of “specific” lymphocytes. “Early detection translates into more effective therapies, which in turn increases the chance of success and survival,” notes Lapointe; “with this resource we hope to make considerable advances in this direction.”