Laparoscopic ultrasonography for staging of gastrointestinal malignancy

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 metastases/ingrowth. 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 tumor 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