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Staging laparoscopy in patients with hepatocellular carcinoma: is it useful?

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Abstract

Background

Staging laparoscopy (SL) is not regularly performed for patients with hepatocellular carcinoma (HCC). It may change treatment strategy, preventing unnecessary open exploration. An additional advantage of SL is possible biopsy of the nontumorous liver to assess fibrosis/cirrhosis. This study aimed to determine whether SL for patients with HCC still is useful.

Methods

Patients with HCC who underwent SL between January 1999 and December 2011 were analyzed. Their demographics, preoperative imaging studies, surgical findings, and histology were assessed.

Results

The 56 patients (34 men and 22 women; mean age, 60 ± 14 years) in this study underwent SL for assessment of extensive disease or metastases. For two patients, SL was unsuccessful because of intraabdominal adhesions. For four patients (7.1 %), SL showed unresectability because of metastases (n = 1), tumor progression (n = 1), or severe cirrhosis in the contralateral lobe (n = 2). An additional five patients did not undergo laparotomy due to disease progression detected on imaging after SL. Exploratory laparotomy for the remaining 47 patients showed 6 (13 %) additional unresectable tumors due to advanced tumor (n = 5) or nodal metastases (n = 1). Consequently, the yield of SL was 7 % (95 % confidence interval (CI), 3–17 %), and the accuracy was 27 % (95 % CI, 11–52 %). A biopsy of the contralateral liver was performed for 45 patients who underwent SL, leading to changes in management for 4 patients (17 %) with cirrhosis.

Conclusions

The overall yield of SL for HCC was 7 %, and the accuracy was 27 %. When accurate imaging methods are available and additional percutaneous liver biopsy is implemented as a standard procedure in the preoperative workup of patients with HCC, the benefit of SL will become even less.

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References

  1. Higashi T, Hatano E, Ikai I, Nishii R, Nakamoto Y, Ishizu K, Suga T, Kawashima H, Togashi K, Seo S, Kitamura K, Takada Y, Uemoto S (2010) FDG PET as a prognostic predictor in the early post-therapeutic evaluation for unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 37:468–482

    Article  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  3. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917

    Article  PubMed  Google Scholar 

  4. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J (2001) Clinical management of hepatocellular carcinoma: conclusions of the Barcelona–2000 EASL conference. European association for the study of the liver. J Hepatol 35:421–430

    Article  PubMed  CAS  Google Scholar 

  5. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022

    Google Scholar 

  6. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  7. Jansen MC, van HR, Chamuleau RA, van Delden OM, Gouma DJ, van Gulik TM (2005) Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol 31:331–347

    Article  PubMed  CAS  Google Scholar 

  8. Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in. J Hepatol 48(Suppl 1):S20–S37

    Article  PubMed  CAS  Google Scholar 

  9. Liu JG, Wang YJ, Du Z (2010) Radiofrequency ablation in the treatment of small hepatocellular carcinoma: a meta analysis. World J Gastroenterol 16:3450–3456

    Article  PubMed  Google Scholar 

  10. de Graaf GW, Ayantunde AA, Parsons SL, Duffy JP, Welch NT (2007) The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol 33:988–992

    Article  PubMed  Google Scholar 

  11. Kapiev A, Rabin I, Lavy R, Chikman B, Shapira Z, Kais H, Poluksht N, Amsalam Y, Halpern Z, Markon I, Wassermann I, Halevy A (2010) The role of diagnostic laparoscopy in the management of patients with gastric cancer. Isr Med Assoc J 12:726–728

    PubMed  Google Scholar 

  12. Muntean V, Mihailov A, Iancu C, Toganel R, Fabian O, Domsa I, Muntean MV (2009) Staging laparoscopy in gastric cancer: accuracy and impact on therapy. J Gastrointest Liver Dis 18:189–195

    Google Scholar 

  13. Ellsmere J, Mortele K, Sahani D, Maher M, Cantisani V, Wells W, Brooks D, Rattner D (2005) Does multidetector-row CT eliminate the role of diagnostic laparoscopy in assessing the resectability of pancreatic head adenocarcinoma? Surg Endosc 19:369–373

    Article  PubMed  CAS  Google Scholar 

  14. Stefanidis D, Grove KD, Schwesinger WH, Thomas CR Jr (2006) The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Ann Oncol 17:189–199

    Article  PubMed  CAS  Google Scholar 

  15. Connor S, Barron E, Wigmore SJ, Madhavan KK, Parks RW, Garden OJ (2005) The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma. J Gastrointest Surg 9:476–480

    Article  PubMed  Google Scholar 

  16. Weber SM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR (2002) Staging laparoscopy in patients with extrahepatic biliary carcinoma: analysis of 100 patients. Ann Surg 235:392–399

    Article  PubMed  Google Scholar 

  17. Karanicolas PJ, Elkin EB, Jacks LM, Atoria CL, Strong VE, Brennan MF, Coit DG (2011) Staging laparoscopy in the management of gastric cancer: a population-based analysis. J Am Coll Surg 213:644–651

    Article  PubMed  Google Scholar 

  18. Lai EC, Tang CN, Ha JP, Tsui DK, Li MK (2008) The evolving influence of laparoscopy and laparoscopic ultrasonography on patients with hepatocellular carcinoma. Am J Surg 196:736–740

    Article  PubMed  Google Scholar 

  19. Lo CM, Lai EC, Liu CL, Fan ST, Wong J (1998) Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg 227:527–532

    Article  PubMed  CAS  Google Scholar 

  20. Lo CM, Fan ST, Liu CL, Poon RT, Lam CM, Yuen WK, Yeung C, Wong J (2000) Determining resectability for hepatocellular carcinoma: the role of laparoscopy and laparoscopic ultrasonography. J Hepatobiliary Pancreat Surg 7:260–264

    Article  PubMed  CAS  Google Scholar 

  21. Montorsi M, Santambrogio R, Bianchi P, Opocher E, Cornalba GP, Dapri G, Bonavina L, Zuin M, Podda M (2001) Laparoscopy with laparoscopic ultrasound for pretreatment staging of hepatocellular carcinoma: a prospective study. J Gastrointest Surg 5:312–315

    Article  PubMed  CAS  Google Scholar 

  22. de GW, van Lienden KP, van Gulik TM, Bennink RJ (2010) (99 m)Tc-mebrofenin hepatobiliary scintigraphy with SPECT for the assessment of hepatic function and liver functional volume before partial hepatectomy. J Nucl Med 51:229–236

    Article  Google Scholar 

  23. de Graaf W, van Lienden KP, Dinant S, Roelofs JJ, Busch OR, Gouma DJ, Bennink RJ, van Gulik TM (2010) Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection. J Gastrointest Surg 14:369–378

    Article  PubMed  Google Scholar 

  24. Bhargava DK, Verma K, Dasarathy S (1991) Laparoscopic and histological features of hepatocellular carcinoma. Indian J Med Res 94:424–425

    PubMed  CAS  Google Scholar 

  25. Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D (1991) A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group Protocol 6584. J Clin Oncol 9:1105–1112

    PubMed  Google Scholar 

  26. Babineau TJ, Lewis WD, Jenkins RL, Bleday R, Steele GD Jr, Forse RA (1994) Role of staging laparoscopy in the treatment of hepatic malignancy. Am J Surg 167:151–154

    Article  PubMed  CAS  Google Scholar 

  27. Poon D, Anderson BO, Chen LT, Tanaka K, Lau WY, Van CE, Singh H, Chow WC, Ooi LL, Chow P, Khin MW, Koo WH (2009) Management of hepatocellular carcinoma in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol 10:1111–1118

    Article  PubMed  Google Scholar 

  28. Sano K, Ichikawa T, Motosugi U, Sou H, Muhi AM, Matsuda M, Nakano M, Sakamoto M, Nakazawa T, Asakawa M, Fujii H, Kitamura T, Enomoto N, Araki T (2011) Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology 261:834–844

    Article  PubMed  Google Scholar 

  29. Claudon M, Cosgrove D, Albrecht T, Bolondi L, Bosio M, Calliada F, Correas JM, Darge K, Dietrich C, D’Onofrio M, Evans DH, Filice C, Greiner L, Jager K, Jong N, Leen E, Lencioni R, Lindsell D, Martegani A, Meairs S, Nolsoe C, Piscaglia F, Ricci P, Seidel G, Skjoldbye B, Solbiati L, Thorelius L, Tranquart F, Weskott HP, Whittingham T (2008) Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS)–update 2008. Ultraschall Med 29:28–44

    Article  PubMed  CAS  Google Scholar 

  30. Bolog N, Andreisek G, Oancea I, Mangrau A (2011) CT and MR imaging of hepatocellular carcinoma. J Gastrointest Liver Dis 20:181–189

    Google Scholar 

  31. Low RN, Gurney J (2007) Diffusion-weighted MRI (DWI) in the oncology patient: value of breathhold DWI compared to unenhanced and gadolinium-enhanced MRI. J Magn Reson Imaging 25:848–858

    Article  PubMed  Google Scholar 

  32. Parikh T, Drew SJ, Lee VS, Wong S, Hecht EM, Babb JS, Taouli B (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822

    Article  PubMed  Google Scholar 

  33. Nieveen van Dijkum EJ, de Wit LT, van Delden OM, Rauws EA, van Lanschot JJ, Obertop H, Gouma DJ (1997) The efficacy of laparoscopic staging in patients with upper gastrointestinal tumors. Cancer 79:1315–1319

    Article  PubMed  CAS  Google Scholar 

  34. Ruys AT, Busch OR, Gouma DJ, van Gulik TM (2011) Staging laparoscopy for hilar cholangiocarcinoma: is it still worthwhile? Ann Surg Oncol 18:2647–2653

    Article  PubMed  Google Scholar 

  35. Belli G, Fantini C, Belli A, Limongelli P (2011) Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes. Dig Surg 28:134–140

    Article  PubMed  Google Scholar 

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Disclosures

Lisette T. Hoekstra, Matthanja Bieze, Olivier R. C. Busch, Dirk J. Gouma, and Thomas M. van Gulik have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Lisette T. Hoekstra, Matthanja Bieze, Olivier R. C. Busch, Dirk J. Gouma & Thomas M. van Gulik

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  1. Lisette T. Hoekstra
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  2. Matthanja Bieze
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  3. Olivier R. C. Busch
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Correspondence to Lisette T. Hoekstra.

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Hoekstra, L.T., Bieze, M., Busch, O.R.C. et al. Staging laparoscopy in patients with hepatocellular carcinoma: is it useful?. Surg Endosc 27, 826–831 (2013). https://doi.org/10.1007/s00464-012-2519-6

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  • DOI: https://doi.org/10.1007/s00464-012-2519-6

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