Selective use of diagnostic laparoscopy prior to planned hepatectomy for patients with hepatocellular carcinoma Journal Article
| Authors: | Weitz, J.; D'Angelica, M.; Jarnagin, W.; Gonen, M.; Fong, Y.; Blumgart, L.; DeMatteo, R. |
| Article Title: | Selective use of diagnostic laparoscopy prior to planned hepatectomy for patients with hepatocellular carcinoma |
| Abstract: | Background. Patients with hepatocellular carcinoma (HCC) are frequently found to be inoperable at surgical exploration. Laparoscopy may reduce the rate of unnecessary laparotomy in these patients. However, there are no criteria for selective use of laparoscopy. Methods. Sixty patients with potentially operable HCC underwent laparoscopy prior to planned partial hepatectomy. Intraoperative findings and postoperative course were analyzed, and factors for the selective use of laparoscopy were identified. Results. Fourteen of 19 inoperable patients (74%) were identified by means of laparoscopy, which increased the resectability rate from 68% to 89%. Compared with patients undergoing exploratory laparotomy only, patients determined to be inoperable on laparoscopy had significantly less intraoperative blood loss, a shorter operating room time, and a briefer hospital stay. In a multivariate analysis, clinically apparent liver cirrhosis and radiologic evidence of major vascular invasion or bilobar tumors predicted the likelihood of finding inoperable disease at laparoscopy. The initial use of laparoscopy avoided unnecessary laparotomy in almost 30% of patients with - but only 5% of patients without - these features. Conclusions. If high-risk patients with HCC are selectively targeted, the yield of laparoscopy is increased and unnecessary laparotomy may be avoided. In patients without cirrhosis, major vascular invasion, or bilobar tumors, the yield of laparoscopy is low and is therefore not generally recommended. |
| Keywords: | adult; controlled study; aged; aged, 80 and over; middle aged; major clinical study; postoperative period; liver cell carcinoma; liver cirrhosis; patient selection; treatment planning; carcinoma, hepatocellular; liver neoplasms; cancer patient; preoperative care; neoplasm staging; laparoscopy; laparotomy; preoperative evaluation; prospective studies; diagnostic imaging; prediction; high risk patient; cancer invasion; length of stay; statistical analysis; intraoperative period; operation duration; hepatectomy; neoplasm invasiveness; partial hepatectomy; humans; human; male; female; priority journal; article; multivariate analysis of variance |
| Journal Title: | Surgery |
| Volume: | 135 |
| Issue: | 3 |
| ISSN: | 0039-6060 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2004-03-01 |
| Start Page: | 273 |
| End Page: | 281 |
| Language: | English |
| DOI: | 10.1016/j.surg.2003.07.004 |
| PROVIDER: | scopus |
| PUBMED: | 14976477 |
| DOI/URL: | |
| Notes: | Surgery -- Cited By (since 1996):18 -- Export Date: 16 June 2014 -- CODEN: SURGA -- Source: Scopus |
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