The prognosis of patients with hepatocellular carcinoma (HCC) may be improved with the appropriate selection of treatment, which depends on the accurate identification of all hepatic lesions, including size, number, and location. Non-therapeutic laparotomy and its associated morbidity may be prevented by the detection of unresectable disease with staging laparoscopy. Since peritoneal disease is uncommon with HCC, surface laparoscopy may be less valuable compared with laparoscopic ultrasound.
Patients with primary hepatic tumors who are candidates for curative resection based on preoperative identification of size and location of disease with adequate hepatic reserve.
Patients with known unresectable hepatic disease such as major vessel or organ invasion are not candidates for surgery
The identification of hepatic tumors using triphasic CT scan is less sensitive than laparoscopic ultrasound in correlation studies and is highly dependent on tumor size: 0-1 cm (71%), 1-2 cm (84%), 2-3 cm (96%), and greater than 3 cm (100%). Laparoscopic ultrasound can detect 9.5% more tumors than CT alone, most of which are less than 1 cm. Staging laparoscopy correctly identifies 63-67% of patients with unresectable disease. The most common reasons that staging laparoscopy missed unresectable disease were vascular invasion, lymph node metastases, and adjacent organ invasion. With the combination of staging laparoscopy and laparoscopic ultrasound, 16-25% of patients may avoid open laparotomy.
Procedure-related complications are uncommon, and no mortality has been reported. Bleeding, infection, bowel injury, bile leak, and anesthesia-related complications may occur. Compared with open exploration, patients undergoing Staging laparoscopy with laparoscopic ultrasound have been reported to have shorter hospital stay (9 vs. 2.2 – 5 days, respectively) and earlier time to adjuvant therapy (23 vs. 6 days, respectively) (level II, III) [2-3]. No adverse oncologic effects of the procedure have been described.
- Foroutani A, Garland AM, Berber E, et al. Laparoscopic ultrasound vs triphasic computed tomography for detecting liver tumors. Arch Surg 2000;135:933-938.
- Jarnagin WR, Bodniewicz J, Dougherty E, Conlon K, Blumgart LH, Fong Y. A prospective analysis of staging laparoscopy in patients with primary and secondary hepatobiliary malignancies. J Gastroint Surg 2000; 4:34-43.
- Lo CM, Lai EC, Liu CL, Fan ST, Wong J. Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg 1998;227:527-532.