BACKGROUND: The aim of this study was to evaluate the utility of staging laparoscopy in patients with biliary cancers in the era of modern diagnostic imaging. METHODS: From September 2002 through August 2004, 39 consecutive patients with potentially resectable cholangiocarcinoma underwent preoperative staging laparoscopy before laparotomy. Preoperative imaging included ultrasonography and triphasic computed tomography for all patients and magnetic resonance cholangiography in 35 patients (90%). Final pathological diagnosis included 20 hilar cholangiocarcinomas (HC), 11 intrahepatic cholangiocarcinomas (IHC), and eight gallbladder carcinomas (GBC). RESULTS: During laparoscopy, unresectable disease was found in 14/39 patients (36%). The main causes of unresectability were peritoneal carcinomatosis (11/14) and liver metastases (5/14). At laparotomy, nine patients (37%) were found to have advanced disease precluding resection. Vascular invasion and nodal metastases were the main causes of unresectability during laparotomy (eight out of nine). In detecting peritoneal metastases and liver metastases, laparoscopy had an accuracy of 92 and 71%, respectively. All patients with vascular or nodal involvement were missed by laparoscopy. For prediction of unresectability disease, the yield and accuracy of laparoscopy were highest for GBC (62% yield and 83% accuracy), followed by IHC (36% yield and 67% accuracy) and HC (25% yield and 45% accuracy) CONCLUSION: Staging laparoscopy ensured that unnecessary laparotomy was not performed in 36% of patients with potentially resectable biliary carcinoma after extensive preoperative imaging. In patients with biliary carcinoma that appears resectable, staging laparoscopy allows detection of peritoneal and liver metastasis in one third of patients. Both vascular and lymph nodes invasions were not diagnosed by this procedure. Due to these limitations, laparoscopy is more useful in ruling out dissemination in GBC and IHC than in HC.
BACKGROUND: The aim of this study was to evaluate the utility of staging laparoscopy in patients with biliary cancers in the era of modern diagnostic imaging. METHODS: From September 2002 through August 2004, 39 consecutive patients with potentially resectable cholangiocarcinoma underwent preoperative staging laparoscopy before laparotomy. Preoperative imaging included ultrasonography and triphasic computed tomography for all patients and magnetic resonance cholangiography in 35 patients (90%). Final pathological diagnosis included 20 hilar cholangiocarcinomas (HC), 11 intrahepatic cholangiocarcinomas (IHC), and eight gallbladder carcinomas (GBC). RESULTS: During laparoscopy, unresectable disease was found in 14/39 patients (36%). The main causes of unresectability were peritoneal carcinomatosis (11/14) and liver metastases (5/14). At laparotomy, nine patients (37%) were found to have advanced disease precluding resection. Vascular invasion and nodal metastases were the main causes of unresectability during laparotomy (eight out of nine). In detecting peritoneal metastases and liver metastases, laparoscopy had an accuracy of 92 and 71%, respectively. All patients with vascular or nodal involvement were missed by laparoscopy. For prediction of unresectability disease, the yield and accuracy of laparoscopy were highest for GBC (62% yield and 83% accuracy), followed by IHC (36% yield and 67% accuracy) and HC (25% yield and 45% accuracy) CONCLUSION: Staging laparoscopy ensured that unnecessary laparotomy was not performed in 36% of patients with potentially resectable biliary carcinoma after extensive preoperative imaging. In patients with biliary carcinoma that appears resectable, staging laparoscopy allows detection of peritoneal and liver metastasis in one third of patients. Both vascular and lymph nodes invasions were not diagnosed by this procedure. Due to these limitations, laparoscopy is more useful in ruling out dissemination in GBC and IHC than in HC.
Authors: W R Jarnagin; Y Fong; R P DeMatteo; M Gonen; E C Burke; J Bodniewicz BS; M Youssef BA; D Klimstra; L H Blumgart Journal: Ann Surg Date: 2001-10 Impact factor: 12.969
Authors: M D'Angelica; Y Fong; S Weber; M Gonen; R P DeMatteo; K Conlon; L H Blumgart; W R Jarnagin Journal: Ann Surg Oncol Date: 2003-03 Impact factor: 5.344
Authors: Saxon Connor; Emma Barron; Stephen J Wigmore; Krishnakumar K Madhavan; Rowan W Parks; O James Garden Journal: J Gastrointest Surg Date: 2005-04 Impact factor: 3.452
Authors: O M van Delden; L T de Wit; E J Nieveen van Dijkum; N J Smits; D J Gouma; J W Reeders Journal: J Ultrasound Med Date: 1997-01 Impact factor: 2.153
Authors: Steven R Alberts; Hani Al-Khatib; Michelle R Mahoney; Lawerence Burgart; Peter J Cera; Patrick J Flynn; Tom R Finch; Ralph Levitt; Harold E Windschitl; James A Knost; Loren K Tschetter Journal: Cancer Date: 2005-01-01 Impact factor: 6.860
Authors: Hauke Lang; Georgios C Sotiropoulos; Nils R Frühauf; Marco Dömland; Andreas Paul; Eva-Maria Kind; Massimo Malagó; Christoph E Broelsch Journal: Ann Surg Date: 2005-01 Impact factor: 12.969
Authors: J R A Skipworth; S W M Olde Damink; C Imber; J Bridgewater; S P Pereira; M Malagó Journal: Aliment Pharmacol Ther Date: 2011-09-20 Impact factor: 8.171
Authors: Adam D Barlow; Guiseppe Garcea; David P Berry; Arumugam Rajesh; Roshni Patel; Matthew S Metcalfe; Ashley R Dennison Journal: Langenbecks Arch Surg Date: 2013-09-01 Impact factor: 3.445
Authors: Thomas A Aloia; Nicolas Járufe; Milind Javle; Shishir K Maithel; Juan C Roa; Volkan Adsay; Felipe J F Coimbra; William R Jarnagin Journal: HPB (Oxford) Date: 2015-08 Impact factor: 3.647