SUPERIOR STAGING OF LIVER-TUMORS WITH LAPAROSCOPY AND LAPAROSCOPIC ULTRASOUND

Objective The authors describe the technique of staging laparoscopy wi th laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors, and assess its impact on the selection of patients for hepatic resection with curative intent. Summary Backg round Data Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention. Laparoscopic ultrasonography is a new technique that combines the pri nciples of high resolution intraoperative contact ultrasound with thos e of the laparoscopic examination, and thus, allows the laparoscopist to perform detailed assessment of the liver. Methods This study analyz es a cohort of 50 consecutive patients who were diagnosed as having po tentially resectable liver tumors, and in whom staging laparoscopy was successfully undertaken. Laparoscopic ultrasonography was performed i n 43 patients, and the impact of the Ensuing findings on the decision to proceed to operative assessment of resectability is examined. The r esectability rate in those patients assessed laparoscopically and subs equently submitted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed. Results La paroscopy demonstrated factors precluding curative resection in 23 pat ients (46%). Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients (33%), and provided staging information in addition to that derived from laparoscopy alone in 18/ 43 patients (42%). The resectability rate was significantly higher amo ng those patients undergoing laparoscopic staging (93%) compared with those in whom operative assessment was undertaken without laparoscopy (58%). Conclusions Staging laparoscopy with laparoscopic ultrasonograp hy optimizes patient selection for liver resection with curative inten t.