Staging laparoscopy and laparoscopic ultrasonography in more than 400 patients with upper gastrointestinal carcinoma

Background: Resection offers the only chance of cure to patients with esoph ageal, gastroesophageal junction, and hepatopancreatobiliary tumors. Stagin g is essential to select patients who will benefit from operation because p alliation can also be performed nonoperatively. Several studies, including limited numbers of patients, have shown that laparoscopic staging prevents unnecessary laparotomies, but it is doubtful whether general application of this staging method can be advised. The aim of this study was to assess th e benefit of diagnostic laparoscopy for staging patients with esophageal, g astroesophageal junction, and hepatopancreatobiliary tumors. Study Design: Between June 1992 and December 1996, 420 patients with a rese ctable tumor after conventional staging underwent diagnostic laparoscopy co mbined with laparoscopic ultrasonography. Histologic proof df metastases or ingrowth was used to cancel laparotomy. Results: Laparoscopic staging avoided laparotomy in 20% of patients (sensit ivity 0.70): 5% with an esophageal tumor, 20% with a gastroesophageal junct ion tumor, 15% with a periampullary tumor, 40% with a proximal bile duct tu mor, 35% with a liver tumor, and 40% with a pancreatic body or tail tumor. Complications and port-site metastases were seen in 4% and 2% of patients, respectively Conclusions: Laparoscopic staging is a safe procedure with low morbidity an d without mortality in this series. It has shown no benefit in esophageal c ancer, but seems beneficial for staging tumors located at the gastroesophag eal junction, proximal bile duct tumors, liver tumors, and pancreatic body and tail tumors. The value of laparoscopic staging for patients with periam pullary tumors is not as great as stated in previous studies and is still t he subject of investigation. (J Am Coll Surg 1999;189:459-465. (C) 1999 by the American College of Surgeons).