The evolving influence of laparoscopy and laparoscopic ultrasonography on patients with hepatocellular carcinoma.
BACKGROUND
With the recent introduction of laparoscopic partial hepatectomy and laparoscopic/open radiofrequency ablation for hepatocellular carcinoma (HCC), the role of preoperative laparoscopic staging may be expanded. The objective of this study was to determine the role of preoperative laparoscopy and laparoscopic ultrasonography (USG) in patients with HCC.


METHODS
From January 2001 to April 2007, a cohort of 122 consecutive patients with a diagnosis of potentially resectable HCC underwent staging laparoscopy with laparoscopic USG before performing a major laparotomy in a tertiary referral center. The patients' data were collected prospectively. We have retrospectively analyzed the effect of implementation of this staging technique in our center.


RESULTS
Preoperative laparoscopy and laparoscopic USG was successful in 119 patients (97.5%). Forty-four patients were found to be unresectable after laparoscopic staging, whereas 2 patients were found to be unresectable after exploratory laparotomy. The total number of patients who underwent curative liver resection was 73 (laparoscopic partial hepatectomy, 22 patients; open partial hepatectomy, 51 patients). The median hospital stay of the laparoscopic liver resection group was significantly shorter than that of the open resection group (8 vs 13 d; P = .002). Intraoperative treatment for patients with unresectable HCC, including local ablative therapy, or combined liver resection and local ablative therapy, was performed in 27 of 45 inoperable patients (60%) (laparoscopic approach, 8 patients; open approach, 19 patients). The median hospital stay of the laparoscopic treatment group was significantly shorter than for the open treatment group for patients with unresectable HCC (5 vs 7 d; P = .003). In this study, a laparoscopic treatment approach for HCC was performed in 25.2% of the study population.


CONCLUSIONS
Laparoscopy and laparoscopic USG have a significant effect both on identifying surgically untreatable disease and in selecting the optimal treatment strategy. Some patients will benefit from a laparoscopic therapy approach. Therefore, it argues for more widespread use in laparoscopic staging procedures for patients with potentially resectable HCC.
Lai
Eric C H
EC
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd., Chai Wan, Hong Kong, China. ericlai@alumni.cuhk.edu.hk
Tang
Chung Ngai
CN
Ha
Joe P Y
JP
Tsui
David K K
DK
Li
Michael K W
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional