A prospective analysis of staging laparoscopy in patients with primary andsecondary hepatobiliary malignancies

Laparoscopy and laparoscopic ultrasound are used widely in cancer staging a nd are perceived to prevent unnecessary open exploration in many patients. The aim of this study was to analyze the impact of staging laparoscopy in i mproving resectability in patients with primary and secondary hepatobiliary malignancies. Over a 10-month period (November 1, 1997 to August 31, 1998) , 186 patients with primary and secondary hepatobiliary cancers were submit ted to operation for potentially curative resection. One hundred four patie nts staged laparoscopically (LAP) before laparotomy were compared prospecti vely to 82 patients undergoing exploration without laparoscopy (NO LAP). As signment to each group was not random but was based on surgeon practice. De mographic data, diagnoses, the extent of preoperative evaluation, and the p ercentage of patients resected were similar in the two groups. Laparoscopy identified 26 (67%) of 39 patients with unresectable disease. In the NO LAP group, 28 patients (34%) had unresectable disease discovered at laparotomy In patients with unresectable disease and submitted to biopsy only, the op erating times were similar in the two groups (LAP 83 +/- 22 minutes vs, NO LAP 91 +/- 33 minutes; P = 0.4). However, laparoscopic staging significantl y reduced the length of hospital stay (LAP 2.2 +/- 2 days vs. SO LAP 8.5 +/ - 8.6 days; P = 0.006). Likewise, total hospital charges, normalized to 100 in the NO LAP patients, were significantly longer in the LAP group (LAP 54 +/- 42 vs. NO LAP 100 +/- 84; P = 0.02). Staging laparoscopy identified th e majority of patients with unresectable hepatobiliary malignancies, signif icantly improved resectability and reduced the number of days in the hospit al and the total charges. The yield of laparoscopy was greatest for detecti ng peritoneal metastases (9 of 10), additional hepatic turners (10 of 12), and unsuspected advanced cirrhosis (5 of 5) but often failed to identify; n onresectability because of lymph node metastases, vascular involvement, or extensive biliary involvement. Eighty-three percent of patients subjected t o laparotomy after laparoscopy underwent a potentially curative resection c ompared to 66% of those who were not staged laparoscopically.