Abstract
BackgroundNearly half of patients with perihilar cholangiocarcinoma (PHC) have incurable tumors at laparotomy. Staging laparoscopy (SL) potentially detects metastases or locally advanced disease, thereby avoiding unnecessary laparotomy. However, the diagnostic yield of SL has decreased with improved imaging in recent years.ObjectiveThe aim of this study was to identify predictors for detecting metastasized or locally advanced PHC at SL and to develop a risk score to select patients who may benefit most from this procedure.MethodsData of patients with potentially resectable PHC who underwent SL between 2000 and 2015 in our center were retrospectively analyzed. Multivariable logistic regression analysis was used to identify independent predictors and to develop a preoperative risk score.ResultsUnresectable PHC was detected in 41 of 273 patients undergoing SL (yield 15 %). Overall sensitivity of SL was 30 %, with highest sensitivity for detecting peritoneal metastases (73 %). Preoperative imaging factors that were independently associated with unresectability at SL were tumor size ≥4.5 cm, bilateral portal vein involvement, suspected lymph node metastases, and suspected (extra)hepatic metastases on imaging without the possibility of diagnosis by percutaneous- or endoscopic ultrasound-guided biopsy. The derived preoperative risk score showed good discrimination to predict unresectability (area under the curve 0.77, 95 % confidence interval 0.68–0.86) and identified three subgroups with a predicted low-risk of 7 % (N = 203 patients), intermediate-risk of 21 % (N = 39), and high-risk of 58 % (N = 31).ConclusionsA selective approach for SL in PHC is recommended since the overall yield is low. The proposed preoperative risk score is useful in selecting patients for SL.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5531-6) contains supplementary material, which is available to authorized users.
Highlights
Half of patients with perihilar cholangiocarcinoma (PHC) have incurable tumors at laparotomy
Laparoscopy was performed in the event of suspicious metastatic lesions on imaging for which diagnosis by percutaneous- or endoscopic ultrasound (EUS)-guided biopsy was not feasible or when pathological results of biopsies were inconclusive with persistent suspicion of metastatic disease
Preoperative staging was performed with ultrasound, computed tomography (CT) in most patients (97 %), and more selectively with magnetic resonance imaging (MRI) (38 %) and positron emission tomography (PET; 22 %)
Summary
Half of patients with perihilar cholangiocarcinoma (PHC) have incurable tumors at laparotomy. Staging laparoscopy (SL) potentially detects metastases or locally advanced disease, thereby avoiding unnecessary laparotomy. The aim of this study was to identify predictors for detecting metastasized or locally advanced PHC at SL and to develop a risk score to select patients who may benefit most from this procedure. Data of patients with potentially resectable PHC who underwent SL between 2000 and 2015 in our center were retrospectively analyzed. Multivariable logistic regression analysis was used to identify independent predictors and to develop a preoperative risk score. Unresectable PHC was detected in 41 of 273 patients undergoing SL (yield 15 %). Preoperative imaging factors that were independently associated with unresectability at SL were tumor size C4.5 cm, bilateral portal vein
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