The Utility of Laparoscopic Assessment in the Preoperative Staging of Suspected Hilar Cholangiocarcinoma

Connor, Saxon; Barron, Emma; Wigmore, Stephen J.; Madhavan, Krishnakumar; Parks, Rowan W.; Garden, O. James

doi:10.1016/j.gassur.2004.10.009

Cited by 76 publications

(59 citation statements)

References 12 publications

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“…2,4,5,9 These time differences are important considering the impact of improved imaging during past years. This is reflected by the proportion of HCCA patients undergoing laparoscopy who were ultimately resected.…”

Section: Discussionmentioning

confidence: 99%

“…This study questions the conclusion of previous studies, including our own published in 2002, that patients with HCCA should undergo SL routinely. [2][3][4][5]9 In the light of our recent results, we have reconsidered the place of SL in our workup of patients with HCCA. Several options may be considered, including: 1) A more selective approach to submitting patients with HCCA for SL, including only patients with Bismuth type 3 and 4 tumors, and patients with suspicion on metastases; 2) The use of SL as a short procedure preceding laparotomy in one session.…”

Section: Discussionmentioning

confidence: 99%

“…In an attempt to prevent an unnecessary laparotomy, staging laparoscopy (SL) has been performed in patients with HCCA, thereby decreasing operative morbidity and length of hospital stay associated with a laparotomy. [2][3][4][5] In 2002, we evaluated the use of SL in patients with malignant proximal bile duct obstruction in our center and concluded, on the basis of a yield of 42%, that SL should be performed routinely in the workup for these patients. 4 The accuracy of radiologic imaging techniques has continued to improve.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?

Ruys

Busch

Gouma

et al. 2012

Indian J Surg Oncol

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Purpose. This study was designed to evaluate the benefit of staging laparoscopy (SL) in patients with suspected hilar cholangiocarcinoma (HCCA) during the past 10 years. Only 50-60% of patients with HCCA who undergo laparotomy are ultimately amenable to a potentially curative resection. In a previous study, we recommended routine use of SL to prevent unnecessary laparotomies. The accuracy of imaging techniques, however, has significantly improved during the past decade, which is likely to impact the yield and accuracy of SL. Methods. From 2000 to 2010, 195 patients with suspected HCCA were analyzed. The yield and accuracy of SL were calculated by dividing total number of avoided laparotomies by the total number of laparoscopies or by all patients with unresectable disease, respectively. Factors associated with better yield and accuracy were assessed. Results. Of 195 patients with HCCA, 175 underwent SL. The yield of SL was 14% and the accuracy was 32%. Operative morbidity of SL was 3%, and operative morbidity of laparotomy for unresectable disease was 33%. No clear factors that influenced the yield of SL were found. Conclusion. Overall yield and accuracy of SL for HCCA in the present series decreased to 14% and 32%, respectively, compared with earlier reports. This finding is likely the result of improved imaging techniques that evolved during the past decade. The place of SL in the workup of patients with HCCA needs to be reconsidered, and one should decide whether the declining additional value of SL still outweighs the drawbacks of SL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?

Ruys

Busch

Gouma

et al. 2012

Indian J Surg Oncol

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“…80% of articles extracted were review articles, whilst the remaining did not assess SL/LUS as staging modality. Of the remaining 41 articles, 12 studies did not satisfy the eligibility criteria; 22 were for potentially resectable PPC and 7 for PBC [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37] (Supplemental information, Table ST1 to attain pneumoperitoneum and were therefore excluded from our analysis. Therefore, a total of 2,827 patients with PPC and 478 patients with PBC, deemed potentially resectable on preoperative staging, were included for analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Proximal biliary cancers **Studies with >100 pts 20 --STARD ≥18 36,37 38 (5-288) 40 (32-47) *Liver metastases 12,19,20,36 512 (100-2620) -*Peritoneal metastases 19,20,36 1937 (249-15071) -Local invasion 12,19,20 66 (10-416) -Studies with LUS only 12,20,37 45 (8-257) -M A N U S C R I P T…”

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confidence: 99%