Staging Laparoscopy in Gallbladder Cancer Is Infrequently Used Despite High Rates of Peroperatively Diagnosed Disseminated Disease

Abstract

Introduction: Staging laparoscopy (SL) is recommended before attempting resection in patients with gallbladder cancer (GBC). The aim of this study was to assess the yield of SL in terms of reducing unnecessary surgical exploration and to delineate factors associated with disseminated disease (DD). Material and methods: Data were collected from all GBC patients undergoing SL and/or surgical exploration in eight Dutch academic hospitals from 2000-2019. Outcomes after laparotomy with or without SL were assessed and factors predictive for DD were identified. Results: A total of 210 patients was included; SL was performed in 43 (20%). SL was more frequently performed in patients with tumor invasion in the liver on pre-operative imaging (53% vs 30%, p=0.014). DD was detected by SL in 8/43 patients (19%). Of the 35 patients with SL that underwent surgical exploration, 25(72%) were resected and in 10 patients (28%) DD was diagnosed during laparotomy. Accuracy of SL for detecting DD was 44%(8/18). Of 167 patients without SL, resection was performed in 125(75%) and in 44(25%) DD was found. DD was most frequently detected at the hepatic hilum (16/44, 36%) and the peritoneum (10/44, 23%). In total, 62 (30%) patients had DD. Liver invasion on imaging was associated with high rates of DD (50/76, 66%) and predictive for DD in multivariate analysis (OR 12.5,P=0.021). Conclusion: SL in GBC is infrequently used despite a 30% chance of occult metastatic disease. In patients with liver invasion on imaging risk of DD is 66% and SL be recommended.Tabled 1Baseline characteristics of patients with and without SLCharacteristicSL (N=43)No SL (N=167)P-valueAge (mean/range)64 (45-86)66 (33-81)0.391ASA >29 (21%)41 (25%)0.690Cholecystitis0 (0%)10 (6%)0.220Primary Sclerosing Cholangitis3 (7%)6 (4%)0.394Gallbladder polyp3 (7%)8 (5%)0.700N1 disease (imaging)8 (35%)28 (36%)0.906Liver invasion (imaging)21 (53%)45 (30%)0.014Pre-operative jaundice18 (42%)54 (32%)0.160Pre-operative biliairy drainage21 (49%)56 (34%)0.063 Open table in a new tab