LAPAROSCOPIC ULTRASONOGRAPHY FOR STAGING OF GASTROINTESTINAL MALIGNANCY

Background: Diagnostic laparoscopy has been used frequently as a preop erative staging procedure for different gastrointestinal malignancies. The assessment of solid abdominal organs and retroperitoneal ingrowth or detection of lymph-node metastasis is limited, however. A recent d evelopment, laparoscopic ultrasonography, will probably increase the p reoperative evaluation of these lesions and thus further improve the p reoperative staging. Method: Since 1993 diagnostic laparoscopy combine d with laparoscopic ultrasonography has been performed as an additiona l diagnostic procedure in patients who have already been selected for curative resection of different GI malignancies. In this prospective s tudy, staging after conventional work-up is compared with the tumour s tage after laparoscopy. All patients underwent exploratory laparotomy except those with histologically proven metastases/ingrowth. Results: For patients with cancer of the esophagus and gastric cardia (n = 56) the preoperative stage was altered in 17% but laparotomy could only be avoided in 5% (for a subgroup of patients with a tumour of the gastri c cardia laparotomy was avoided in 11%). Additional findings during la paroscopy showed that laparotomy could be avoided in 55% of the patien ts (n = 44) with primary liver tumours, liver metastasis or proximal b ile duct tumours. For patients with pancreatic head tumours (n = 73) t he preoperative stage of the tumour changed in 40%; the strategy of tr eatment was changed in 26% and laparotomy could be avoided in 20%. Con clusions: Laparoscopy combined with laparoscopic ultrasonography is ef fective (more accurate) in the staging of gastrointestinal malignancie s, in particular for patients with liver, biliary and pancreatic tumou rs. The preoperative tumour stage changed between 15 and 60% for the d ifferent gastrointestinal malignancies and laparotomy could be avoided in 5-55%. The procedure is highly operator-dependent and has a learni ng curve.