Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?
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.
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.
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.
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.
- Ito F, Cho CS, Rikkers LF, Weber SM. Hilar cholangiocarcinoma: current management. Ann Surg. 2009;250(2):210–8. CrossRef
- Connor S, Barron E, Wigmore SJ, Madhavan KK, Parks RW, Garden OJ. The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2005;9(4):476–80. CrossRef
- Goere D, Wagholikar GD, Pessaux P, Carrere N, Sibert A, Vilgrain V, et al. Utility of staging laparoscopy in subsets of biliary cancers: laparoscopy is a powerful diagnostic tool in patients with intrahepatic and gallbladder carcinoma. Surg Endosc. 2006;20(5):721–5. CrossRef
- Tilleman EH, de Castro SM, Busch OR, Bemelman WA, van Gulik TM, Obertop H, et al. Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction. J Gastrointest Surg. 2002;6(3):426–30. CrossRef
- Weber SM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg. 2002;235(3):392–9 CrossRef
- Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215(1):31–8. CrossRef
- Bemelman WA, van Delden OM, van Lanschot JJ, de Wit LT, Smits NJ, Fockens P, et al. Laparoscopy and laparoscopic ultrasonography in staging of carcinoma of the esophagus and gastric cardia. J Am Coll Surg. 1995;181(5):421–5.
- Bemelman WA, de Wit LT, van Delden OM, Smits NJ, Obertop H, Rauws EJ, et al. Diagnostic laparoscopy combined with laparoscopic ultrasonography in staging of cancer of the pancreatic head region. Br J Surg. 1995;82(6):820–4. CrossRef
- Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234(4):507–17. CrossRef
- Cheng JL, Bruno MJ, Bergman JJ, Rauws EA, Tytgat GN, Huibregtse K. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. Gastrointest Endosc. 2002;56(1):33–9. CrossRef
- Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340(8834–8835):1488–92. CrossRef
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. CrossRef
- Nieveen van Dijkum EJ, de Wit LT, van Delden OM, Kruyt PM, van Lanschot JJ, Rauws EA, et al. Staging laparoscopy and laparoscopic ultrasonography in more than 400 patients with upper gastrointestinal carcinoma. J Am Coll Surg. 1999;189(5):459–65. CrossRef
- Vollmer CM, Drebin JA, Middleton WD, Teefey SA, Linehan DC, Soper NJ, et al. Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies. Ann Surg. 2002;235(1):1–7. CrossRef
- Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, et al. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol. 2008;103(5):1145–51. CrossRef
- Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Annals of Surgical Oncology
Volume 18, Issue 9 , pp 2647-2653
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors