Staging laparoscopy in patients with extrahepatic biliary carcinoma: Analysis of 100 patients Journal Article
| Authors: | Weber, S. M.; DeMatteo, R. P.; Fong, Y.; Blumgart, L. H.; Jarnagin, W. R. |
| Article Title: | Staging laparoscopy in patients with extrahepatic biliary carcinoma: Analysis of 100 patients |
| Abstract: | Objective: To evaluate the benefit of staging laparoscopy in patients with gallbladder cancer and hilar cholangiocarcinoma. Summary Background Data: In patients with extrahepatic biliary carcinoma, unresectable disease is often found at the time of exploration despite extensive preoperative evaluation, thus resulting in unnecessary laparotomy. Methods: From October 1997 to May 2001, 100 patients with potentially resectable gallbladder cancer (n = 44) and hilar cholangiocarcinoma (n = 56) were prospectively evaluated. All patients underwent staging laparoscopy followed by laparotomy if the tumor appeared resectable. Surgical findings, resectability rate, length of stay, and operative time were analyzed. Results: Patients underwent multiple preoperative imaging tests, including computed tomography scan, ultrasound, magnetic resonance cholangiopancreatography, and direct cholangiography. Laparoscopy identified unresectable disease in 35 of 100 patients. In the 65 patients undergoing open exploration, 34 were found to have unresectable disease. Therefore, the overall accuracy for detecting unresectable disease was 51%. There was no difference in the accuracy of laparoscopy between patients with gallbladder cancer and hilar cholangiocarcinoma. Laparoscopy detected the majority of patients with peritoneal or liver metastases but failed to detect all locally advanced tumors. In patients undergoing bïopsy only, laparoscopic identification of unresectable disease significantly laparoduced operative time and length of stay compared with patients undergoing laparotomy. The yield of laparoscopy was 48% in patients with gallbladder cancer (56% in those who did not undergo previous cholecystectomy), but only 25% in patients with hilar cholangiocarcinoma. However, in patients with locally advanced but potentially resectable hilar cholangiocarcinoma, the yield of laparoscopy was greater, 36% (12/33, T2/T3 tumors) versus 9% (2/23, T1 tumors). Conclusions: Laparoscopy identifies the majority of patients with unresectable hilar cholangiocarcinoma or gallbladder carcinoma, thereby reducing both the incidence of unnecessary laparotomy and the length of stay. The yield of laparoscopy is lower for hilar cholangiocarcinoma but can be improved by targeting patients at higher risk of occult unresectable disease. All patients with potentially resectable primary gallbladder cancer and patients with T2/T3 hilar cholangiocarcinoma should undergo staging laparoscopy before surgical exploration. |
| Keywords: | adult; controlled study; aged; aged, 80 and over; middle aged; major clinical study; cancer staging; cancer diagnosis; laparoscopy; diagnostic accuracy; laparotomy; preoperative evaluation; prospective studies; computer assisted tomography; biopsy; length of stay; liver metastasis; echography; operation duration; bile duct carcinoma; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; gallbladder carcinoma; gallbladder neoplasms; peritoneum metastasis; cholangiography; humans; human; male; female; priority journal; article |
| Journal Title: | Annals of Surgery |
| Volume: | 235 |
| Issue: | 3 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2002-03-01 |
| Start Page: | 392 |
| End Page: | 399 |
| Language: | English |
| DOI: | 10.1097/00000658-200203000-00011 |
| PUBMED: | 11882761 |
| PROVIDER: | scopus |
| PMCID: | PMC1422445 |
| DOI/URL: | |
| Notes: | Export Date: 14 November 2014 -- Source: Scopus |
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