title: Role of laparoscopic ultrasound during diagnostic laparoscopy for proximal biliary cancers: a single series of 100 patients.
abstract: BACKGROUND
  Despite extensive preoperative evaluation, a significant proportion of patients with biliary cancer (BC) proves to be unresectable at laparotomy. Diagnostic laparoscopy (DL) has been suggested to avoid unnecessary laparotomy. Aim of the study was to evaluate the additional benefit of combining LUS to DL in patients with proximal BC.
  
  
  METHODS
  Inclusion criteria were all patients affected by proximal BC undergone DL + LUS based on the following criteria: preoperative diagnosis of gallbladder cancer, hilar cholangiocarcinomas (HC) and borderline resectable intrahepatic cholangiocarcinoma (IHC). The overall yield (OY) and accuracy (AC) of DL ± LUS in determining unresectable disease were calculated.
  
  
  RESULTS
  From 01/2006 to 12/2014, 107 out of 191 (56%) potentially resectable proximal BC were evaluated. One hundred patients fulfilled inclusion criteria: 44 IHC, 21 GC and 35 HC. Forty-eight (48%) patients were male with median age of 65 (41-87) years. The median number of preoperative imaging was 3 ± 0.99. Patients underwent DL + LUS 10.5 ± 15.6 days after last imaging. DL + LUS identified unresectable diseases in 24 patients, 6 (25%) of them only thanks to LUS findings (3 GC and 3 IHC). At laparotomy, 6 (4 HC and 2 GC) out of 76 patients were found unresectable because of carcinomatosis (n = 2), new liver metastasis (n = 2) and vascular invasion (n = 2). LUS increased the OY (from 18 to 24%) and AC (from 60 to 80%) in the whole group. The advantages of LUS were confirmed for GC (OY from 38.1 to 52.4%, AC from 61.5 to 84.6%) and IHC patients (OY from 11.4 to 18.2%, AC from 62.5 to 100%) but not for HC group. The presence of biliary drainage was the only factor able to predict negative yield (p < 0.001).
  
  
  CONCLUSIONS
  LUS increases overall yield and accuracy of DL for detecting unresectable disease in patients with preoperative diagnosis of gallbladder cancer and borderline resectable intrahepatic cholangiocarcinomas.
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy. nrussolillo@mauriziano.it.
authors.forename: Nadia
authors.initials: N
authors.lastname: Russolillo
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: D'Eletto
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Langella
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Perotti
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lo Tesoriere
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Forchino
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D018285:Klatskin Tumor / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography
keywords: Accuracy; Biliary cancer; Diagnostic laparoscopy; Laparoscopic ultrasound; Yield