Abstract
Purpose
Accurate preoperative radiological staging of hilar cholangiocarcinoma remains difficult, and a number of patients are found to have irresectable advanced tumours or occult metastases at exploration. Staging laparoscopy can improve the detection of irresectable disease, avoiding unnecessary laparotomy. This study examines the role of staging laparoscopy in hilar cholangiocarcinoma, with a focus on yield over different time periods and identification of preoperative factors increasing the risk of irresectable disease.
Methods
Retrospective case note review of all patients undergoing staging laparoscopy for radiologically resectable hilar cholangiocarcinoma, identified from the hepatobiliary multidisciplinary team database, was performed.
Results
One hundred consecutive patients underwent staging laparoscopy between 1998 and 2011. Of these, 34 patients were found to be irresectable due to metastatic disease, and 11, due to extensive local disease. Fifty patients proceeded to exploratory laparotomy following staging laparoscopy, and 36 % (18/50) of whom were found to have irresectable disease: 12 patients due to advanced local disease and 6 patients due to metastases. The overall yield of laparoscopy was 45 %, and the accuracy was 71 %.
There was no significant difference in age, preoperative bilirubin, neutrophil/lymphocyte ratio, Ca19-9 levels or T stage between patients with resectable disease and with irresectable disease on laparoscopy. There was also no change in the yield of laparoscopy over time, despite advances in radiological imaging.
Conclusion
In this series, staging laparoscopy avoided unnecessary laparotomy in 45 % of patients with radiologically resectable hilar cholangiocarcinoma. No factor was able to predict positive yield, and therefore, all patients with potentially resectable hilar cholangiocarcinoma should undergo staging laparoscopy.
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References
Weber SM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR (2002) Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg 235:392–399
Ruys AT, Busch OR, Gouma DJ, van Gulik TM (2011) Staging laparoscopy for hilar cholangiocarcinoma: is it still worthwhile? Ann Surg Oncol 18:2647–2653
Burke EC, Jarnagin WR, Hochwald SN, Pisters PWT, Fong Y, Blumgart LH (1998) Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 228:385–394
Gomez D, Morris-Stiff G, Toogood GJ, Lodge JP, Prasad KR (2008) Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol 97:513–518
Tilleman EH, de Castro SM, Busch OR, Bemelman WA, van Gulik TM, Obertop H et al (2002) Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction. J Gastrointest Surg 6:426–30, discussion 430–1
Connor S, Barron E, Wigmore SJ, Madhavan KK, Parks RW, Garden OJ (2005) The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma. J Gastrointest Surg 9:476–480
Goere D, Wagholikar GD, Pessaux P, Carrere N, Sibert A, Vilgrain V et al (2006) Utility of staging laparoscopy in subsets of biliary cancers: laparoscopy is a powerful diagnostic tool in patients with intrahepatic and gallbladder carcinoma. Surg Endosc 20:721–725
Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M et al (2007) Combined vascular resection for hilar cholangiocarcinoma: does it work or not? Surgery 141:581–8
Ruys AT, van Beem BE, Engelbrecht MR, Bipat S, Stoker J, van Gulik TM (2012) Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol 85:1255–62
Fritshcer-Ravens A, Bohuslavizki KH, Broering DC, Jenicke L, Schafer H, Buchert R et al (2001) FDG PET in the diagnosis of hilar cholangiocarcinoma. Nucl Med Commun 22:1277–85
Li J, Kuelh H, Grabellus F, Muller SP, Radunz S, Antoch G et al (2008) Preoperative assessment of hilar cholangiocarcinoma by dual modality PET/CT. J Surg Oncol 98:438–43
Ruys AT, Bennink RJ, van Westreenen HL, Engelbrecht MR, Busch OR, Gouma DJ et al (2011) FDG-positron emission tomography/computed tomography and standardized uptake value in the primary diagnosis and staging of hilar cholangiocarcinoma. HPB (Oxford) 13:256–62
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Barlow, A.D., Garcea, G., Berry, D.P. et al. Staging laparoscopy for hilar cholangiocarcinoma in 100 patients. Langenbecks Arch Surg 398, 983–988 (2013). https://doi.org/10.1007/s00423-013-1104-3
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DOI: https://doi.org/10.1007/s00423-013-1104-3