Clinical risk score can be used to select patients for staging laparoscopy and laparoscopic ultrasound for colorectal liver metastases.
BACKGROUND
Despite advanced staging investigations, some patients with potentially resectable colorectal liver metastases (CLM) are unresectable at laparotomy. Staging laparoscopy and laparoscopic ultrasound (Lap + LUS) detects a subset of these unresectable patients before a major laparotomy. Clinical risk scoring may be helpful to identify this subgroup. The goal of our study was to evaluate the role of Lap + LUS and to assess the value of the Memorial Sloan Kettering clinical risk score (CRS) in identifying this subset.


METHODS
Patients were identified from the regional multidisciplinary team (MDT) cancer database and operative records for a 5-year period. All patients whose tumors were deemed resectable proceeded to Lap + LUS. LUS findings were recorded and any change in MDT plan was noted. LUS findings were compared with resectability at open surgery. The CRS (Memorial Sloan-Kettering) based on five factors was calculated.


RESULTS
A total of 79 patients were identified. In 15 of 74 patients, LUS prevented an unnecessary laparotomy by predicting the benign nature of lesions or demonstrating unresectability. The CRS ranged from 0 to 4. Lap + LUS prevented an operation in only 7% of patients with a CRS of < or =2. However in patients with a CRS > 2, Lap + LUS prevented an operation in 24% of patients.


CONCLUSIONS
LUS prevented an unnecessary laparotomy in 20% of patients. This may reduce inpatient stay, morbidity, and mortality, allowing some patients to proceed to palliative treatments earlier. The benefit of Lap + LUS is limited in patients with a CRS of < or =2. It is worth considering selective use of Lap + LUS for the staging of CLM.
Department of Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India. ashah249@gmail.com
A J
AJ
Shah
J
J
Phull
M D
MD
Finch-Jones
D000465:Algorithms; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D014463:Ultrasonography