The Value of Laparoscopic Staging for Patients With Colorectal Metastases

Abstract

Background: Resection offers the only chance of cure for hepatic colorectal metastases. However, preoperative staging does not always reliably detect unresectable disease. The aim of this study was to investigate the role that laparoscopy with ultrasound may have in detecting unresectable disease, thus sparing patients from unnecessary laparotomy with the associated morbidity and cost. Methods: A retrospective review of all patients considered for liver resection of colorectal metastases during a 3-year period was performed, analyzing factors likely to predict resectable disease, rates of resectability, and success of laparoscopic staging at detecting unresectable disease. Results: Of 73 patients with resectable disease on computed tomography, 24 were deemed to need laparos

Laparoscopy for diagnosis and staging of hepatobiliary malignancies

“…18 The yield for DL in these selected 'high-risk' patients was similar to the yield in Rahusen's report (33%) with an identical accuracy (75%) for identification of disease precluding resection. The resection rate in the high-risk group (50%) matched the resection rate reported by Rahusen as well (52%), whereas the resection rate was 94% in 49 patients without highrisk criteria who did not undergo DL.…”

Metachronous liver metastases and resectability: Fong's score and laparoscopic evaluation

“…Resectability can be assessed using imaging techniques such as ultrasound scanning, contrast‐enhanced helical computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET‐CT) 5, 6. A further recent step improving the assessment of resectability consists of diagnostic laparoscopy and ultrasonography (LUS) of the abdominal cavity and liver, which could contribute to avoiding unnecessary laparotomy, as indicated in several series 2, 7–14.…”

Cost‐effectiveness of laparoscopy versus laparotomy for initial surgical evaluation and treatment of potentially resectable hepatic colorectal metastases: a decision analysis

“…This outcome is not surprising at face value. DL is not a particularly costly procedure: in the studies considered for this analysis it added approximately 30 min to the total several-hour operative time of hepatic resection, it used equipment already available at the hospitals, it added very little time to patients' post-operative recovery and was associated with a less than 1% complication rate [9][10][11]18,19]. Furthermore, performing DL prior to laparotomy has some QOL advantage compared to proceeding directly to a potentially unnecessary laparotomy, albeit for only a small subset of the entire cohort in the initial post-operative period.…”

“…One of these studies had particularly careful reporting of key outcomes and a notably larger sample size than the other studies and, as noted above, the probabilities of resectability at laparoscopy and laparotomy from this study were used for the base case analysis. Probabilities from the remaining four cohort studies served as the foundation for sensitivity analyses (see Table I) [9][10][11]18,19].…”