Fd. Rahusen et al., Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography, ANN SURG, 230(1), 1999, pp. 31-37
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.