The role of staging laparoscopy in hepatobiliary malignancy: Prospective analysis of 401 cases Journal Article
| Authors: | D'Angelica, M.; Fong, Y.; Weber, S.; Gonen, M.; DeMatteo, R. P.; Conlon, K.; Blumgart, L. H.; Jarnagin, W. R. |
| Article Title: | The role of staging laparoscopy in hepatobiliary malignancy: Prospective analysis of 401 cases |
| Abstract: | Background: Patients with potentially resectable hepatobiliary malignancy are frequently found to have unresectable tumors at laparotomy. We prospectively evaluated staging laparoscopy in patients with resectable disease on preoperative imaging. Methods: Staging laparoscopy was performed on 410 patients with potentially resectable hepatobiliary malignancy. The preoperative likelihood of resectability was recorded. Data on preoperative imaging, operative findings, and hospital course were analyzed. Results: Laparoscopic inspection was complete in 291 (73%) patients. In total, 153 patients (38%) had unresectable disease, 84 of whom were identified laparoscopically, increasing resectability from 62% to 78%. On multivariate analysis, a complete examination, preoperative likelihood of resection, and primary diagnosis were significant predictors of identifying unresectable disease at laparoscopy. The highest yield was for biliary cancers, and the lowest was for metastatic colorectal cancer. In patients with unresectable disease identified at laparoscopy, the mean hospital stay was 3 days, and postoperative morbidity was 9%, compared with 8 days and 27%, respectively, in patients found to have unresectable disease at laparotomy. Conclusions: Laparoscopy spared one in five patients a laparotomy while reducing hospital stay and morbidity. Targeting laparoscopy to patients at high risk for unresectable disease requires consideration of disease-specific factors; however, the surgeons' preoperative impression of resectability is also important. © 2003 The Society of Surgical Oncology, Inc. |
| Keywords: | adult; controlled study; treatment outcome; aged; middle aged; cancer surgery; major clinical study; disease course; liver neoplasms; cancer staging; methodology; cancer diagnosis; neoplasm staging; laparoscopy; laparotomy; preoperative evaluation; prospective study; prospective studies; colorectal cancer; metastasis; logistic models; morbidity; analytic method; pathology; high risk patient; length of stay; hospitalization; liver tumor; medical record; liver resection; multivariate analysis; biliary tract surgery; bile duct neoplasms; analysis of variance; statistical model; bile duct cancer; bile duct tumor; staging laparoscopy; hepatobiliary system cancer; humans; human; male; female; article; hepatobiliary neoplasms; laparoscopic ultrasound |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 10 |
| Issue: | 2 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2003-03-01 |
| Start Page: | 183 |
| End Page: | 189 |
| Language: | English |
| DOI: | 10.1245/aso.2003.03.091 |
| PUBMED: | 12620915 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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