The efficacy of laparoscopic staging in patients with upper gastrointestinal tumors

Abstract

The major advantage of diagnostic laparoscopy for patients with a gastrointestinal tumor is the prevention of unnecessary explorative laparotomies. However, it is doubtful whether this procedure also prevents late laparotomies that are necessary for palliative treatment during follow-up. From January 1992 to July 1995, 233 consecutive patients with gastrointestinal malignancies underwent laparoscopy and laparoscopic ultrasonography after routine diagnostic procedures had shown potential curative disease. After diagnostic laparoscopy, laparotomy was not performed in 21% of all patients (47 of 226) because of histologically proven, unresectable, mainly metastatic disease; 6% had esophageal tumors (4 of 64 patients), 43% had liver tumors (10 of 23), 43% had proximal bile duct tumors (9 of 21), 15% had periampullary tumors (17 of 111), and 43% had pancreatic body and tail tumors (3 of 7). Nonoperative palliation was successful in all patients. However, late laparotomies were necessary in 7 of these 47 patients (15%): 5 patients with periampullary tumors and 2 patients with proximal bile duct tumors. All 7 patients underwent a surgical bypass, most due to duodenal obstruction, 1 to 13 months after diagnostic laparoscopy. In this study, diagnostic laparoscopy may have prevented unnecessary laparotomies for exploration or palliation in 18% of all patients (40 of 226). The procedure is of doubtful benefit for patients with esophageal tumors because the current findings show that only 6% of explorative laparotomies could be prevented. In patients with periampullary tumors, the initial benefit was 15%, but the risk of a late laparotomy is relatively high (30%).