The impact of staging laparoscopy prior to hepatic resection for colorectal metastases.
OBJECTIVE
To evaluate the role of routine laparoscopy as a staging modality prior to laparotomy and hepatic resection for metastatic colorectal cancer.


METHODS
Prospectively collected data were analysed from a database. In the first half of the series patients underwent selective laparoscopy before proceeding to laparotomy and in the second part of the series laparoscopy was used routinely. Patients undergoing laparotomy directly were analysed in Group 1 and those having laparoscopy before laparotomy in Group 2. The ability of laparoscopy to pick up unresectable and extrahepatic disease, resectability rate and open and close laparotomy rate were recorded.


RESULTS
Of the 284 patients, 74 were in Group 1 (no laparoscopy) and 210 in Group 2 (laparoscopy as standard). The resectability rate was 81% in Group 1 and 87% in Group 2. The open and close laparotomy rate was 19% and 8%, respectively (p=0.025). In Group 2 alone, laparoscopy identified 39% of unresectable disease and prevented an open and close procedure.


CONCLUSIONS
Routine use of staging laparoscopy increases the resectability rate and reduces the inoperability rate in these patients.
Khan
A Z
AZ
Regional Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK.
Karanjia
N D
ND
D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome