THE EFFICACY OF LAPAROSCOPIC STAGING IN PATIENTS WITH UPPER GASTROINTESTINAL TUMORS

BACKGROUND. The major advantage of diagnostic laparoscopy for patients with a a gastrointestinal tumor is the prevention of unnecessary expl orative laparotomies. However, it is doubtful whether this procedure a lso prevents late laparotomies that are necessary for palliative treat ment during follow-up. METHODS. From January 1992 to July 1995, 233 co nsecutive patients with gastrointestinal malignancies underwent laparo scopy and laparoscopic ultrasonography after routine diagnostic proced ures had shown potential curative disease. RESULTS. After diagnostic l aparoscopy, laparotomy was not performed in 21% of all patients (47 of 226) because of histologically proven, unresectable, mainly metastati c disease; 6% had esophageal rumors (4 of 64 patients), 43% had liver tumors (10 of 23), 43% had proximal bile duct tumors (9 of 21), 15% ha d periampullary rumors (17 of 111), and 43% had pancreatic body and ta il tumors (3 of 7). Nonoperative palliation was successful in all pati ents. However, late laparotomies were necessary in 7 of these 47 patie nts (15%): 5 patients with periampullary tumors and 2 patients with pr oximal bile duct tumors. All 7 patients underwent a surgical bypass, m ost due to duodenal obstruction, 1 to 13 months after diagnostic lapar oscopy. CONCLUSIONS. In this study, diagnostic laparoscopy may have pr evented unnecessary laparotomies for exploration or palliation in 18% of all patients (40 of 226). The procedure is of doubtful benefit for patients with esophageal tumors because the current findings show that only 6% of explorative laparotomies could be prevented. In patients w ith periampullary tumors, the initial benefit was 15%, but the risk of a late laparotomy is relatively high (30%). (C) 1997 American Cancer Society.