Staging laparoscopy promotes increased utilization of postoperative therapy for unresectable intra-abdominal malignancies

Staging laparoscopy avoids unnecessary laparotomies in patients with unrese ctable intra-abdominal malignancies. However, the postoperative oncologic t reatment of these patients has not been documented. This study compares rat es and timing of postoperative chemotherapy (ChT) and/or radiation therapy (XRT) in patients with unresectable intra-abdorninal malignancies initially evaluated by staging laparoscopy (SL) or exploratory laparotomy (E-L). The records of patients surgically evaluated for esophageal, gastric, hepatobi liary, and pancreatic cancers or abdominal lymphoma were retrospectively re viewed. Data gathered included type of exploration (SL or EL), resectabilit y, whether postoperative cancer treatment was given (ChT, XRT, or both), an d the time from surgery to the beginning of such treatment. This study incl udes only patients with unresectable malignancies. Twenty-one patients unde rwent SL and 58 EL. Sixteen of the SL patients (76%) and 25 of the EL patie nts (43%) received postoperative cancer treatment (P = 0.009). The median n umber of days from surgery to postoperative cancer treatment was 13 days (r ange 5 to 41 days) for the SL group and 35 days (range 16 to 89 days) for t he EL group (P = 0.0004). We conclude that patients with unresectable intra -abdominal malignancies discovered by SL are more likely to receive postope rative ChT and/or XRT than patients surgically evaluated by EL. Further stu dies to determine whether this better utilization of postoperative treatmen t results in better outcomes in these patients are needed.