STAGING LAPAROSCOPY WITH LAPAROSCOPIC ULTRASONOGRAPHY - OPTIMIZING RESECTABILITY IN HEPATOBILIARY AND PANCREATIC MALIGNANCY

Background: Open laparotomy has traditionally been required to stage h epatobiliary and pancreatic (HBP) cancers accurately. For unresectable patients, costs and morbidity have been high. Today, laparoscopy alon e or combined with laparoscopic ultrasonography (LUS) is being examine d for its value in defining the extent of malignancy. Study Design: We have analyzed the effect of routine implementation of this new stagin g technique in our HBP center. Staging laparoscopy (SL) with LUS was p erformed in 50 consecutive patients with HBP malignancies. All patient s were considered to have resectable tumors as determined by tradition al preoperative staging modalities. Primary tumors were located in the liver (n = 7), biliary tract (n = 11), or pancreas (n = 32). An avera ge of 2.7 preoperative studies per patient were performed prior to SL- LUS. Results: Staging laparoscopy with laparoscopic ultrasonography pr edicted resectable tumors in 28 patients (56%). At laparotomy, 26 of 2 8 were actually resectable: the false-negative rate was 49%. Staging l aparoscopy with laparoscopic ultrasonography indicated unresectability in 22 patients (44%). Staging laparoscopy alone demonstrated previous ly unrecognized occult metastases in 11 patients (22%). In 11 other pa tients (22%) in whom SL alone was negative, LUS established unresectab ility from vascular invasion (n = 5), lymph node metastases (n = 5), o r intraparenchymal hepatic tumor (n = 1). All cases of unresectability due to vascular invasion were validated by laparotomy. Five of six ly mph node or hepatic metastases were proved histologically by LUS-guide d needle biopsy rather than laparotomy. Conclusions: Unnecessary lapar otomy can be safely avoided by SL-LUS in many patients with HPB malign ancies, reducing costs and morbidity. (C) 1997 by the American College of Surgeons.