IS LAPAROSCOPIC EVALUATION OF DIGESTIVE CANCERS LEGITIMATE - A PROSPECTIVE-STUDY OF 109 CASES

This aims of this study is to evaluate after laparoscopic exploration or treatment in digestive cancers, the incidence of port site metastas es and the incidence of unnecessary laparotomy in advanced disease. Pa tients: 109 patients were included in this study: 91 had localized dig estive cancers and IS had disseminated disease with hepatic and:or per itoneal metastases. Methods: All the patients underwent a laparoscopy and a laparoscopic ultra-sonography under general anesthesia prior to a definitive decision on therapeutic management. Depending on the circ umstances: histological or cytological biopsies were pel formed. The p uncture sites of the trocar were examined clinically and,if required, by ultrasonography, monthly through out the course course disease. Che motherapy was instigated in 60.5 per cent of patients. Results: 35 pat ients (32.1 per cent) only had one laparoscopic examination with a mea n survival of 4,8 months, 22.9 per cent of patients had laparoscopic t reatment of their lesion and 44.9 per cent had conventional treatment. Laparoscopic exploration allowed the detection of 52 lesions that had not been identified by conventional imaging techniques and thereby av oided 35 laparotomies (32.1 per cent). Tumor invasion of the peritoneu m was present in 46 per cent of cases, most notably in the cases of pa ncreatico-biliary cancers. The overall mean survival was 32.7 months w hile it was 9.8 months in cases of palliative treatment. In total, 436 trocars were used. There was one case (0.9 per cent of patient or 0.0 2 per cent of port) of a metastasis occuring at the site of the trocar following treatment by right-sided, laparoscopic colectomy in a patie nt with disseminated cancer. Two factors seem to be involved peritonea l spread of the tumor and manipulation of the tumor. Conclusions. Lapa roscopic exploration for digestive cancers is a legitimate technique. It allows the detection of lesions that are nor identified by conventi onal imaging techniques, permits a more accurate assessment of the res ectability of a tumor and reduces the number of unnecessary laparotomi es. The incidence of metastases at the site of the trocar is low and i s closely linked to the presence of disseminated disease and manipulat ion of the tumor.