A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases

BACKGROUND, Laparoscopy may identify occult metastatic disease and prevent unnecessary laparotomy in some patients with potentially resectable colorec tal liver metastases but is unnecessary in the majority of individuals who undergo resection. The objectives of the current study were to assess the i mpact of laparoscopy after extensive preoperative imaging and to determine whether a preoperative clinical risk score can identify those patients most likely to benefit from the procedure. METHODS. Between December 1997 and July 1999, 103 consecutive patients with potentially resectable colorectal liver metastases underwent laparoscopy p rior to planned laparotomy and partial hepatectomy. Surgical findings, leng th of hospital stay, and hospital charges were analyzed. Patients were assi gned a clinical risk score (CRS) based on five factors related to the prima ry tumor and the hepatic disease. The likelihood of finding occult unresect able disease and the yield of laparoscopy were analyzed with respect to the CRS. RESULTS, Seventy-seven patients (75%) underwent resection. Laparoscopy iden tified 14 of 26 patients with unresectable disease, 10 of whom were spared an unnecessary laparotomy. in patients who underwent biopsy only, the lapar oscopic identification of unresectable disease shortened the hospital stay (1.2 +/- 0.6 days vs. 5.8 +/- 2.3 days; p = 0.0001) and reduced the total h ospital charges by 55% (P = 0.0001). The CRS predicted the likelihood of oc cult unresectable disease, which was 12% in those with a score less than or equal to 2 but increased to 42% in those with a score > 2 (P = 0.001). If laparoscopy were used only in high risk patients (CRS > 2), 57 laparoscopie s would have been avoided and the net savings doubled. CONCLUSIONS, With extensive preoperative imaging, the vast majority of pati ents with potentially resectable hepatic colorectal metastases do not benef it from laparoscopy. However, in the minority of patients with occult unres ectable disease, laparoscopy prevents unnecessary laparotomy and reduces ho spital stay and the total hospital charges. The CRS, previously shown to pr edict survival after hepatic resection, identifies those high risk patients most likely to benefit from laparoscopy and may improve resource utilizati on. Cancer 2001;91:1121-8, (C) 2001 American Cancer Society.