PRETHERAPEUTIC ASSESSMENT OF RESECTABILITY IN PATIENTS WITH UPPER GASTROINTESTINAL-TRACT CANCER BY USING A COMBINATION OF ENDOSCOPIC ULTRASONOGRAPHY (EUS) AND LAPAROSCOPY

An accurate pretherapeutic assessment of resectability in patients wit h upper gastrointestinal malignancies (UGIM) is mandatory in order to choose the optimal treatment strategy. Endoscopic ultrasonography (EUS ) has significantly reduced the need for exploratory laparotomy in pat ients with UGIM, but the pretherapeutic evaluation in about 10% of the patients is incomplete due to certain limitations of the EUS. We pros pectively evaluated the use and results of diagnostic laparoscopy in p atients with UGIM selected for this procedure by EUS. In six patients with incomplete EUS, laparoscopy demonstrated nonresectability in five patients and a resectable tumor in one patient, and laparoscopy thus filled the informational gap in all cases. In addition, laparoscopy co nfirmed nonresectability in ten patients in whom EUS had suggested non resectability. By employing the combinated use of EUS and laparoscopy it seems possible to avoid a great number of futile laparoscopies, and it should also reduce the need for explorative laparotomies. Larger p rospective studies have been initiated and might be able to confirm th is.