A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases

Jarnagin, William R.; Conlon, Kevin C.; Bodniewicz, Jessica; Dougherty, Ellen; DeMatteo, Ronald P.; Blumgart, Leslie H.; Fong, Yuman

doi:10.1002/1097-0142(20010315)91:6<1121::aid-cncr1108>3.0.co;2-2

Cited by 138 publications

(99 citation statements)

References 29 publications

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“…With optimal preoperative evaluation including ultrasound, modern triphasic helical CT and MRI [33] , the yield of laparoscopic staging has decreased and the majority of patients with potentially respectable hepatic colorectal metastasis may not benefit from SL [34] . We previously reported [23] that the yield of laparoscopy staging was lowest for metastatic colorectal cancer compared to other hepatobiliary malignancies.…”

Section: Liver Metastasismentioning

confidence: 99%

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Gaujoux

Allen

2010

WJGS

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Even after extensive preoperative assessment, staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease. Staging laparoscopy is associated with decreased postoperative pain, a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques. Current uses of staging laparoscopy include the following: (1) In the staging of pancreatic adenocarcinoma, laparoscopic staging allows for the identification of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and, in radiographically resectable cancer, may identify metastatic disease in 10%-15% of cases; (2) In colorectal liver metastases, selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients; (3) In hepatocellular carcinoma, laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors; and (4) In biliary tract malignancy, staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma. Because of the decreasing yield of SL secondary to improvements in imaging techniques, staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization. Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.

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Section: Liver Metastasismentioning

confidence: 99%

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Gaujoux

Allen

2010

WJGS

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“…14, 27-30 The most commonly used and reliable referral scoring system for prognosis world-wide is the MSKCC-CRS reported by Fong et al and Jarnagin et al, 14,31 which identifies those high-risk patients most likely to benefit from laparoscopy and preoperative imaging. The CRS > 2 would indicate a poor prognosis 7 in the case of the hepatectomy group in the present study; we divided this group into two groups (CRS 0-2 vs. CRS 3-4).…”

Section: Comprehensive Grading System For Colorectal Liver Metastasismentioning

confidence: 99%

Relationship between period of survival and clinicopathological characteristics in patients with colorectal liver metastasis

Nanashima

Araki

Tobinaga

et al. 2009

European Journal of Surgical Oncology (EJSO)

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Aim: Cancer death in the early period after hepatectomy still remains in patients with colorectal liver metastasis (CLM). We examined the relationship between clinicopathological parameters and survival periods in 130 CLM patients who underwent hepatectomy. Patients/methods:Patients were divided into four groups: Group 1 (5-year survivors without tumor relapse), Group 2 (survivors at 2-5 years), Group 3 (cancer death at 2-5 years), and Group 4 (cancer death within 2 years).Results: A short surgical margin was frequent in Group 4 compared to Group 1 (31 vs 78%, p < 0.05). Primary node-positive status, absence of fibrous pseudo-capsular formation, higher Clinical Risk Score, and tumor recurrence within 12 months were frequent in Group 4 (p < 0.05). Multivariate analysis revealed a short surgical margin (HR; 3.5) and early tumor relapse (HR; 5.9) as independently significant related parameters (p < 0.05). Conclusions:A sufficient surgical margin, or careful follow-up for early tumor relapse may be important to improve outcomes after surgery in CLM patients.

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“…However, complications are reported to be as high as 28%, including pneumonia and myocardial infarction [59]. The hospital length of stay is demonstrated to be significantly shorter for SL (1.2 days) than for open laparotomy (5.8 days) [60]. A 55% reduction in total hospital charges, with the greatest savings in room and board charges, has been reported with SL compared with open exploration (level 2 evidence) [60].…”

Section: Staging Laparoscopy For Colorectal Cancermentioning

confidence: 99%

“…Furthermore, SL and laparoscopic ultrasound have better sensitivity than noninvasive imaging studies for the detection of nodal metastases (94% for laparoscopic ultrasound vs 18% for preoperative imaging) [62]. The combination of SL and laparoscopic ultrasound is reported to detect unresectable disease in 25-42% of patients for whom preoperative radiologic testing showed potentially curable disease [59,60]. The use of laparoscopic ultrasound can further identify unresectable disease, which may not be seen with laparoscopic inspection alone [60].…”

Section: Staging Laparoscopy For Colorectal Cancermentioning

confidence: 99%

“…The combination of SL and laparoscopic ultrasound is reported to detect unresectable disease in 25-42% of patients for whom preoperative radiologic testing showed potentially curable disease [59,60]. The use of laparoscopic ultrasound can further identify unresectable disease, which may not be seen with laparoscopic inspection alone [60]. In addition, the findings of the procedure have altered the management for 33% to 48% of patients [59,62,63].…”

Section: Staging Laparoscopy For Colorectal Cancermentioning

confidence: 99%

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The role of staging laparoscopy for intraabdominal cancers: an evidence-based review

et al. 2008

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Diagnostic laparoscopy is minimally invasive surgery for the diagnosis of intraabdominal diseases. The aim of this review is a critical examination of the available literature on the role of laparoscopy for the staging of intraabdominal cancers. A systematic literature search of English-language articles on MEDLINE, the Cochrane database of evidence-based reviews, and the Database of Abstracts of Reviews of Effects was performed for the period 1995-2006. The level of evidence in the identified articles was graded. The search identified and reviewed seven main categories that have received attention in the literature: esophageal cancer, gastric cancer, pancreatic cancer, hepatocellular carcinoma, biliary tract cancer, colorectal cancer, and lymphoma. The indications, contraindications, risks, benefits, diagnostic accuracy of the procedure, and its associated morbidity are discussed. The limitations of the available literature are highlighted, and evidence-based recommendations for the use of laparoscopy to stage intraabdominal cancers are provided.

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A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases

Cited by 138 publications

References 29 publications

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Relationship between period of survival and clinicopathological characteristics in patients with colorectal liver metastasis

The role of staging laparoscopy for intraabdominal cancers: an evidence-based review

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