title: The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma.
abstract: The aim of this study was to review the role of laparoscopic assessment in the staging algorithm of suspected hilar cholangiocarcinoma and to identify factors highly likely to be associated with unresectable disease. Data prospectively collected between 1992 and 2003 were analyzed. Demographics, symptoms, preoperative radiologic staging, laparoscopic assessment, and final outcome were recorded. Yield was defined as the number of unresectable patients detected by laparoscopic assessment divided by the total number of patients undergoing laparoscopic assessment. Accuracy was defined as the number of unresectable patients detected by laparoscopic assessment divided by the total number of unresectable cases. Eighty-four patients underwent laparoscopic assessment for suspected hilar cholangiocarcinoma, of which 20 (23.8%) underwent resection. The yield from laparoscopy alone was 24.3% (20 of 82), which increased to 41.5% (35 of 82) with the addition of intraoperative ultrasound. The overall accuracy was 53.1% (35 of 66). The use of a preoperative radiologic staging system predicted the likelihood of unresectable disease (P=0.007). The use of laparoscopic assessment in the preoperative staging of patients with suspected hilar cholangiocarcinoma is justified given it will spare 42.2% of patients an unnecessary laparotomy. Accurate staging of cholangiocarcinoma remains a challenge, but the use of a preoperative radiologic staging system may help to stratify a patient's risk of unresectable disease.
authors.affiliation: Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: Saxon
authors.initials: S
authors.lastname: Connor
authors.forename: Emma
authors.initials: E
authors.lastname: Barron
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
authors.forename: Krishnakumar K
authors.initials: KK
authors.lastname: Madhavan
authors.forename: Rowan W
authors.initials: RW
authors.lastname: Parks
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
mesh_terms: D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014463:Ultrasonography