Laparoscopic Ultrasonography for Staging of Gastrointestinal Malignancy

Abstract

Lanschot JJB, Obertop H. Laparoscopic ultrasonography for staging of gastrointestinal malignancy. Scand J Gastroenterol 1996;31 Suppl 218:4349.Background: Diagnostic laparoscopy has been used frequently as a preoperative staging procedure for different gastrointestinal malignancies. The assessment of solid abdominal organs and retroperitoneal ingrowth or detection of lymph-node metastasis is limited, however. A recent development, laparoscopic ultrasonography, will probably increase the preoperative evaluation of these lesions and thus further improve the preoperative staging. Method: Since 1993 diagnostic laparoscopy combined with laparoscopic ultrasonography has been performed as an additional diagnostic procedure in patients who have already been selected for curative resection of different GI malignancies. In this prospective study, staging after conventional work-up is compared with the tumour stage after laparoscopy. All patients underwent exploratory laparotomy except those with histologically proven metastaseslingrowth. Results: For patients with cancer of the esophagus and gastric cardia (n = 56) the preoperative stage was altered in 17% but laparotomy could only be avoided in 5 % (for a subgroup of patients with a tumour of the gastric cardia laparotomy was avoided in 11%). Additional findings during laparoscopy showed that laparotomy could be avoided in 55% of the patients (n = 44) with primary liver tumours, liver metastasis or proximal bile duct tumours. For patients with pancreatic head tumours (n = 73) the preoperative stage of the tumour changed in 40%; the strategy of treatment was changed in 26% and laparotomy could be avoided in 20%. Conclusions: Laparoscopy combined with laparoscopic ultrasonography is effective (more accurate) in the staging of gastrointestinal malignancies, in particular for patients with liver, biliary and pancreatic tumours. The preoperative tumour stage changed between 15 and 60% for the different gastrointestinal malignancies and laparotomy could be avoided in 5-55%. The procedure is highly operator-dependent and has a learning curve.

Evaluation of the role of laparoscopic ultrasonography in the staging of oesophagogastric cancers

“…Preoperative staging techniques are key to optimum patient selection and planning therapy to minimise unnecessary intervention and discomfort to the patient. We did not note any significant difference in detecting metastatic disease when using staging laparoscopy alone in both the centres in our study, and our yield rate is consistent with other studies [14][15][16]. On the other hand, in centre B, the addition of laparoscopic ultrasound picked up abnormality in a further nine patients in whom the staging laparoscopy showed the disease to be suitable for resection thus increasing the detection of metastases by 8% (p = 0.001).…”

“…Some authors believe that the role of LUS may be limited in cancers involving the upper and middle thirds of the oesophagus [6,15].…”

Laparoscopic four-way ultrasound probe with histologic biopsy facility using a flexible tru-cut needle

“…In large series, 21-34% of potentially resectable patients were assessed as nonresectable using laparoscopy [4,6,13]. When laparoscopic ultrasound was added, a further 9-22% were assessed as non-resectable [2,3,5,7,9].…”

Laparoscopic Liver Resection in the Netherlands: How Far Are We?

“…Later, the indications were extended to fenestration of liver cysts and anatomic liver resections [27,28,29,30,31,32]. The group of Cuesta et al [19] was in 1995 the first to report two cases of limited laparoscopic liver surgery of segment II and IV in the Netherlands.…”