title: Diagnostic laparoscopy for primary and secondary liver malignancies: impact of improved imaging and changed criteria for resection.
abstract: BACKGROUND
  Diagnostic laparoscopy (DL) combined with laparoscopic ultrasonography (LUS) has previously shown positive results as a staging modality for liver malignancies. Recent improvements in noninvasive diagnostic imaging techniques such as multiphasic spiral computed tomography, together with the policy that bilobar disease or the number of lesions is no longer considered an absolute exclusion criterion for curative resection, could reduce the additional value of DL. This study retrospectively analyzed the efficacy of DL combined with LUS for liver malignancies to assess the effect of improved imaging and changed criteria for resection.
  
  
  METHODS
  All patients with primary or metachronous secondary liver malignancy eligible for resection in 1997 to 2002 were included.
  
  
  RESULTS
  DL combined with LUS was performed in 84 consecutive patients (56 men and 28 women; mean age, 59 years) with primary (n = 33) or secondary (n = 51) liver malignancies. DL showed unresectability in 13 patients (39%) with primary malignancy. Exploratory laparotomy showed that an additional 5 (25%) of the remaining 20 patients had unresectable disease. DL showed unresectability in 5 patients (12%) with colorectal liver metastasis (n = 43). At laparotomy, another 7 (18%) of the remaining 38 patients had unresectable disease. In five patients (13%) from the latter group, LUS could not be performed because of adhesions from previous surgery.
  
  
  CONCLUSIONS
  DL combined with LUS is an adequate staging modality for primary liver malignancies. For colorectal liver metastasis, more liberal resection criteria, a high failure rate due to adhesions from previous surgery, and better preoperative imaging probably resulted in a lower efficacy.
authors.affiliation: Academic Medical Center, Department of Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: S M M
authors.initials: SM
authors.lastname: de Castro
authors.forename: E H B M
authors.initials: EH
authors.lastname: Tilleman
authors.forename: O R C
authors.initials: OR
authors.lastname: Busch
authors.forename: O M
authors.initials: OM
authors.lastname: van Delden
authors.forename: J S
authors.initials: JS
authors.lastname: Laméris
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000267:Tissue Adhesions; D036542:Tomography, Spiral Computed