Laparoscopy in the management of colorectal cancer metastatic to the liver.
BACKGROUND
This investigation was undertaken to define the value of laparoscopy in the staging of patients with colorectal carcinoma metastatic to the liver.


METHODS
The clinical details of 59 consecutive patients with colorectal liver metastases undergoing laparoscopy prior to planned hepatectomy were entered prospectively on a computerized database. All patients were staged preoperatively with thin slice (5-7 mm) helical computed tomography chest, abdomen and pelvis. Synchronous metastases were defined as those found during, or on imaging carried out within 1 month of, colorectal resection. Criteria for laparoscopic unresectability were: (i) histologically proven extrahepatic disease; (ii) bilateral inflow or outflow involvement; (iii) the presence of cirrhosis in patients requiring an extended resection (lobectomy or greater); or (iv) hepatic metastases involving more than six hepatic segments.


RESULTS
In 24 patients with synchronous metastases (median age 65 years, range 32-81 years) all were resectable on laparoscopic criteria, of whom 21 were resected. Extrahepatic disease was found at laparotomy in three patients. In 35 patients with metachronous metastases (median age 64 years, range 32-81 years) laparoscopy could not be performed in five patients because of adhesions, and three patients were deemed unresectable on laparoscopic criteria. Of the remaining 27 patients, 25 underwent resection while two proved unresectable. Overall eight of 54 evaluable patients had unresectable disease and laparoscopy correctly identified three patients.


CONCLUSIONS
Following computed tomography scan, 15% of patients with metastatic colorectal carcinoma will be found to have unresectable disease. Laparoscopy will identify approximately half. Laparoscopy is of no greater value in staging synchronous versus metachronous metastases.
Koea
Jonathan
J
Department of Surgery, Hepatobiliary and Upper Gastrointestinal Unit, Auckland Hospital, Private Bag 92024, Auckland, New Zealand. jonathank@adhb.govt.nz
Rodgers
Michael
M
Thompson
Paul
P
Woodfield
John
J
Holden
Andrew
A
McCall
John
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D036542:Tomography, Spiral Computed