Role of laparoscopic ultrasonography in the management of patients with oesophagogastric cancer

Background: Laparoscopy and laparoscopic ultrasonography (lapUS) have been shown to improve the staging of patients with oesophagogastric cancer but t here remains doubt as to whether most benefit follows laparoscopy alone and how much is contributed by the addition of lapUS. Methods: The role of lapUS in surgical decision making was evaluated prospe ctively in a consecutive series of patients with oesophagogastric cancer fo llowing conventional radiological assessment. The results of the lapUS find ings over and above the laparoscopic findings were documented in order to i dentify the additional benefit of lapUS. Results: After initial conventional assessment 41 patients were considered unsuitable for surgery and treated by palliation, with a further 25 patient s proceeding to surgery without laparoscopy. Of the 93 patients who underwe nt laparoscopy, 18 were shown to have irresectable disease and avoided furt her surgery; a further seven avoided inappropriate surgery by the addition of lapUS. The open-close laparotomy rate was reduced from five of 25 in pat ients who did not undergo laparoscopy to nine (12 per cent) of 75 by the in troduction of laparoscopy and to two (3 per cent) of 68 with the addition o f lapUS. Conclusion: Laparoscopy alone prevented unnecessary surgery in 18 (19 per c ent) of 93 patients with oesophagogastric cancer and the addition of lapUS identified a further seven patients (8 per cent) in whom unnecessary surger y was avoided.