Staging of abdominal cancer by local anesthesia outpatient laparoscopy.
OBJECTIVE
Our aim was to review the results of one trocar staging laparoscopies performed under local anesthesia in out patients with intra-abdominal cancer.


METHODS
Two hundred fifteen patients with intra-abdominal cancer (predominantly esophagogastric and pancreatohepatobiliary) underwent one trocar staging laparoscopy on lidocain infiltration anesthesia under conscious sedation. In 43 patients computed tomography (CT) or ultrasonography (US) had raised a suspicion of hepatic metastases, but percutaneous needle biopsy had failed to confirm it; 172 patients had negative CT or US. Peritoneum and liver were examined and biopsies were taken under direct laparoscopic control.


RESULTS
Fourteen patients (7%) received narcotics during the 2-6 hour observation. Mortality was zero. Complications occurred in 5 patients (2%): 1 small bowel perforation (operated), 1 bleeding from the abdominal wall, 1 acute atrial fibrillation, and 2 wound infections. In 79 patients histology demonstrated hepatic or peritoneal metastases. Out of 136 patients 123 were operated in whom laparoscopy did not demonstrate metastases. Thirty-eight of these were unresectable at laparotomy: Five patients (4%) had peritoneal or liver metastases and 33 (27%) proved locally inoperable. The sensitivity of laparoscopy to ascertain peritoneal or liver metastases was 94%.


CONCLUSIONS
We conclude that one trocar local anesthesia outpatient laparoscopy is a fairly safe and effective method to detect peritoneal and liver metastases in abdominal cancer.
Sand
J
J
Department of Surgery, Tampere University Hospital, Finland.
Marnela
K
K
Airo
I
I
Nordback
I
I
D000008:Abdominal Neoplasms / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001706:Biopsy / Q000379:methods; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010044:Outpatient Clinics, Hospital; D010534:Peritoneal Neoplasms / Q000556:secondary; D012189:Retrospective Studies