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Laparoscopic Ultrasound in Staging of GI Malignancies

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Abstract

Cancer staging is the process by which the degree of progression of a primary malignancy beyond its site of origin is determined. Given that the only curative treatment for most gastrointestinal cancers is surgical resection, staging is essential in planning treatment. The accuracy of staging has improved in recent years as a direct result of better imaging: computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET-CT) and endoscopic ultrasound (EUS) are now widely employed in the assessment of malignancy and the planning of treatment. Despite improvements in the spatial resolution of cross-sectional imaging modalities, these remain relatively poor in determining the presence of peritoneal disease, and all have limitations in the assessment of local progression.

Laparoscopy has a clear benefit over cross-sectional imaging in its ability to directly visualise peritoneal disease and to directly biopsy abnormalities. The addition of laparoscopic ultrasonography (LUS) has advantages depending on the underlying diagnosis. Laparoscopy is used commonly in oesophagogastric surgery, and although LUS may downstage gastric cancer, its use is not recommended in guidelines. In colorectal liver metastases and hepatocellular carcinoma, studies quote useful LUS yields, but its use in staging alone is now less common given the improved sensitivity of cross-sectional imaging for these conditions. It is a particularly useful though in aiding laparoscopic interventions such as ablation. In pancreaticobiliary cancers including pancreas carcinoma and cholangiocarcinoma, LUS has a useful place in identifying irresectable patients who can be palliated by endoscopic or percutaneous means, thus avoiding a laparotomy. It is in these conditions that LUS still plays a significant role in staging in many centres worldwide.

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Authors and Affiliations

  1. Department of Clinical Surgery, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    Ewen M. Harrison MB, ChB, PhD, FRCS & O. James Garden CBE, FRCSEd, FRSE

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  1. Ewen M. Harrison MB, ChB, PhD, FRCS
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  2. O. James Garden CBE, FRCSEd, FRSE
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Correspondence to O. James Garden CBE, FRCSEd, FRSE .

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Editors and Affiliations

  1. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, USA

    Ellen J. Hagopian

  2. Department of Surgery, John A. Burns School of Medicine, University of Hawaii and Kuakini Medical Center, Honolulu, Hawaii, USA

    Junji Machi

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Intraoperative ultrasonography to determine relationship of large colorectal liver. Metastasis to vascular structures. A local resection was being considered, but ultrasonography clearly shows the tumour abutting the segment VIII pedicle with no resection margin possible at this structure (AVI 71641 kb)

Intraoperative ultrasonography to determine relationship of large colorectal liver. metastasis to vascular structures. Ultrasonography clearly shows the tumour abutting the segment VIII pedicle with no resection margin possible at this structure. In addition, there is indenting and possible invasion of the right hepatic vein. The patient has a successful open right hepatectomy (AVI 86495 kb)

A patient with a suspicious liver lesion which on LUS is demonstrated to be an intrahepatic gallstone (AVI 78351 kb)

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Harrison, E.M., Garden, O.J. (2014). Laparoscopic Ultrasound in Staging of GI Malignancies. In: Hagopian, E., Machi, J. (eds) Abdominal Ultrasound for Surgeons. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9599-4_10

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