Laparoscopy with laparoscopic ultrasound for pretreatment staging of hepatocellular carcinoma: A prospective study

Laparoscopy with laparoscopic ultrasound (L-LUS) has proved to be superior to conventional CT imaging in the staging of hepatocellular carcinoma (HCC) . The aim of our prospective study was to evaluate the efficacy of L-LUS as compared with currently available imaging techniques (spiral CT or Lipiodo l CT) in patients with HCC and liver cirrhosis. From January 1998 to May 20 00, 70 consecutive patients (50 men and 20 women; mean age 67 +/- 7 years) were enrolled. Liver cirrhosis was related to chronic hepatitis C virus inf ection in 55, hepatitis B virus infection in seven, and alcohol abuse in ei ght patients. Preoperative diagnostic workup included the following: 70 ult rasound examinations of the liver, 23 CT scans after Lipiodol arteriography , and 53 spiral CT scans. A single lesion was found in 39 patients, two les ions in 20 patients, and three lesions in 11 patients. L-LUS was performed in all patients under general anesthesia using a two- to three-trocar techn ique. The examination was completed in 68 patients (97%); in two cases exte nsive adhesions prevented the L-LUS examination. L-LUS yielded additional i nformation in 39 patients (57%). New histologically proved HCC lesions were detected in 14 patients tin the same liver segment in 4 cases and in diffe rent liver segments in 10 cases), and an adrenal metastasis was seen in one patient. Ln 23 patients, benign nodules were identified as regenerative ma cronodules, low-grade dysplastic nodules, or small hemangiomas. In 10 patie nts, correct localization of the primary lesion was detected by L-LUS in co mparison with the preoperative liver location. In our experience, L-LUS is a safe and reliable procedure. It provides superior information (intraopera tive histologic confirmation) for the diagnosis and pretreatment staging of HCC in patients with cirrhosis when compared with current radiologic imagi ng techniques.