Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography

Objective To assess the value of diagnostic laparoscopy (DL) and laparoscopic ultraso nography (LUS) in the staging and selection of patients with colorectal liv er metastasis. Summary Background Data Preoperative imaging modalities such as ultrasound, computed tomography, an d magnetic resonance imaging are limited in the assessment of the number an d exact location of hepatic metastases and in the detection of extrahepatic metastatic disease. Consequently, the surgeon is often faced with a discre pancy between preoperative imaging results and perioperative findings, resu lting in either a different resection than planned or no resection at all. Methods Fifty consecutive patients were planned for DL and LUS in a separate surgic al sitting to assess the resectability of their liver metastases. Ail patie nts were considered to be candidates for resection on the basis of preopera tive imaging studies. Results Laparoscopy could not be performed in 3 of the 50 patients because of dense adhesions. The remaining 47 patients underwent DL. On the basis of DL and LUS, 18 (38%) patients were ruled out as candidates for resection. Of the 2 9 patients who subsequently underwent open exploration and intraoperative u ltrasonography, another 6 (13%) were deemed to have unresectable disease. Conclusions The combination of DL and LUS significantly improves the selection of candi dates for resection of colorectal liver metastases and effectively reduces the number of unnecessary laparotomies.