A reappraisal of staging laparoscopy in three subtypes of cholangiocarcinoma: A multi-institution analysis from the U.S. Extrahepatic Biliary Malignancy Consortium.

Abstract

226 Background: Staging laparoscopy (SL) has been shown to be useful in extrahepatic biliary tumors (EHBTs) to avoid unnecessary laparotomies in unresectable disease. However, the added value of SL for EHBTs has not been well characterized in the era of modern imaging. Methods: We reviewed patients from ten institutions who underwent attempted resection of EHBTs between 1998 and 2015, including gallbladder, distal, and hilar subtypes. Yield of laparoscopy = (Number of positive SL / Total number of SL). Accuracy of laparoscopy = (Number of positive SL / Patients with unresectable disease). These data were compared by use of the chi-squared test and significance was p <.05. Results: A total of 1,075 patients were taken to the OR for attempted curative resection, of which 250 patients (23%) underwent staging laparoscopy. SL identified unresectable disease in 42 patients (yield 17%). Of 208 patients who underwent exploratory laparotomy (EL) after negative SL, 19 were found to be unresectable (false negative rate 9%). Amongst gallbladder, hilar, and distal pathology types, the yield of SL were 18%, 13%, 17%, respectively (p=0.78). Accuracy of SL was 61%, 71%, and 91% respectively (p=0.17), with an accuracy of 68%. A total of 825 patients went directly to EL, of which 103 (13%) failed. The rate of failure for patients going straight to EL was significantly higher for patients with gallbladder (n=66/287, 23%) when compared with hilar (n=15/274, 6%) and distal EHBT (n=22/264, 8%) (p<0.001). Conclusions: Our analysis demonstrates that staging laparoscopy still has added utility in preventing unnecessary laparotomies in unresectable disease for selected patients with EHBTs, although the overall yield is low. Patients with gallbladder cancer had high rates of failed laparotomies, representing a subset who may benefit from more frequent use of staging laparoscopy at the time of resection. [caption]Yield and accuracy of detecting unresectable disease with staging laparoscopy. [/caption] [Table: see text]