title: Risk of occult irresectable disease at liver resection for hepatic colorectal cancer metastases: a contemporary analysis.
abstract: BACKGROUND
  Traditionally, rates of irresectable disease at laparotomy for colorectal liver metastases (CRLM) have ranged from 15 to 70%. Diagnostic laparoscopy has been shown to be effective at preventing nontherapeutic laparotomy in selected patients. The purpose of this study was to analyze the resectability rate and role of diagnostic laparoscopy in a contemporary cohort.
  
  
  METHODS
  Using a prospectively maintained database, we identified patients who were explored for presumed resectable CRLM. Clinical and pathologic data associated with the finding of irresectable disease were analyzed.
  
  
  RESULTS
  From 2008-2010, 455 patients were explored. Of these, 35 (7.7%) did not undergo a resection and/or ablation. Of the 35 patients with irresectable disease, 15 (43%) had disease limited to the liver, 17 (49%) had extrahepatic disease (EHD), and 3 (9%) had other reasons precluding resection. Of the whole cohort, 45 patients (9.9%) were found to have EHD, and 27 of these (60%) underwent complete resection or ablation. The only factor associated with irresectable disease was a prior history of EHD, which was present in 29% of those found irresectable versus 13% of those resected (p = 0.022). Diagnostic laparoscopy was performed in 55 patients. Four of these patients had irresectable disease, and three were spared unnecessary laparotomy. Therefore, the yield was 5% and the sensitivity 75%.
  
  
  CONCLUSIONS
  The finding of irresectable disease is a rare event with modern radiologic assessment and the expansion of indications for resection. Diagnostic laparoscopy has a low yield and should be considered if there is a history of EHD or suspicious findings on preoperative imaging.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
authors.forename: Kai A
authors.initials: KA
authors.lastname: Bickenbach
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: T
authors.initials: T
authors.lastname: Peter Kingham
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010534:Peritoneal Neoplasms / Q000556:secondary*; D018709:Statistics, Nonparametric; D055815:Young Adult