STAGING OF ABDOMINAL CANCER BY LOCAL-ANESTHESIA OUTPATIENT LAPAROSCOPY

Background/Aims: Our aim was to review the results of one trocar stagi ng laparoscopies performed under Local anesthesia in outpatients with intra-abdominal cancer. Materials and Methods: Two hundred fifteen pat ients with intra-abdominal cancer (predominantly esophagogastric and p ancreatohepatobiliary) underwent one trocar staging laparoscopy on lid ocain infiltration anesthesia under conscious sedation. lit 43 patient s computed tomography (CT) or ultrasonography (US) had raised a suspic ion of hepatic metastases, but percutaneous needle biopsy had failed t o confirm it; 172 patients had negative CT or US. Peritoneum and liver were examined and biopsies mere taken under direct laparoscopic contr ol. Results: Fourteen patients (7%) received narcotics during the 2-6 hour observation. Mortality was zero. Complications occurred in. 5 pat ients (2%): 1 small bowel perforation (operated), 1 bleeding from the abdominal wall, I acute atrial fibrillation, and 2 wound infections. I n 79 patients histology demonstrated hepatic or peritoneal metastases. Out of 136 patients 123 were operated in whom laparoscopy did not dem onstrate metastases. Thirty-eight of these were unresectable at laparo tomy: Five patients (4%) had peritoneal or liver metastases and 33 (27 %) proved locally inoperable. The sensitivity of laparoscopy to ascert ain peritoneal or Liver metastases was 94%. Conclusions: We conclude t hat one trocar local anesthesia outpatient laparoscopy is a fairly saf e and effective method to detect peritoneal and liver metastases in ab dominal cancer.