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Role of laparoscopic ultrasound during diagnostic laparoscopy for proximal biliary cancers: a single series of 100 patients

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Abstract

Background

Despite extensive preoperative evaluation, a significant proportion of patients with biliary cancer (BC) proves to be unresectable at laparotomy. Diagnostic laparoscopy (DL) has been suggested to avoid unnecessary laparotomy. Aim of the study was to evaluate the additional benefit of combining LUS to DL in patients with proximal BC.

Methods

Inclusion criteria were all patients affected by proximal BC undergone DL + LUS based on the following criteria: preoperative diagnosis of gallbladder cancer, hilar cholangiocarcinomas (HC) and borderline resectable intrahepatic cholangiocarcinoma (IHC). The overall yield (OY) and accuracy (AC) of DL ± LUS in determining unresectable disease were calculated.

Results

From 01/2006 to 12/2014, 107 out of 191 (56 %) potentially resectable proximal BC were evaluated. One hundred patients fulfilled inclusion criteria: 44 IHC, 21 GC and 35 HC. Forty-eight (48 %) patients were male with median age of 65 (41–87) years. The median number of preoperative imaging was 3 ± 0.99. Patients underwent DL + LUS 10.5 ± 15.6 days after last imaging. DL + LUS identified unresectable diseases in 24 patients, 6 (25 %) of them only thanks to LUS findings (3 GC and 3 IHC). At laparotomy, 6 (4 HC and 2 GC) out of 76 patients were found unresectable because of carcinomatosis (n = 2), new liver metastasis (n = 2) and vascular invasion (n = 2). LUS increased the OY (from 18 to 24 %) and AC (from 60 to 80 %) in the whole group. The advantages of LUS were confirmed for GC (OY from 38.1 to 52.4 %, AC from 61.5 to 84.6 %) and IHC patients (OY from 11.4 to 18.2 %, AC from 62.5 to 100 %) but not for HC group. The presence of biliary drainage was the only factor able to predict negative yield (p < 0.001).

Conclusions

LUS increases overall yield and accuracy of DL for detecting unresectable disease in patients with preoperative diagnosis of gallbladder cancer and borderline resectable intrahepatic cholangiocarcinomas.

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Authors and Affiliations

  1. Department of General and Oncological Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62, 10128, Turin, Italy

    Nadia Russolillo, Marco D’Eletto, Serena Langella, Serena Perotti, Roberto Lo Tesoriere, Fabio Forchino & Alessandro Ferrero

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  1. Nadia Russolillo
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  2. Marco D’Eletto
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  3. Serena Langella
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  4. Serena Perotti
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  5. Roberto Lo Tesoriere
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  6. Fabio Forchino
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  7. Alessandro Ferrero
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Correspondence to Nadia Russolillo.

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Disclosures

Drs. Nadia Russolillo, Marco D’Eletto, Serena Langella, Serena Perotti, Roberto Lo Tesoriere, Fabio Forchino, and Alessandro Ferrero have no conflict of interest or financial ties to disclose.

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Russolillo, N., D’Eletto, M., Langella, S. et al. Role of laparoscopic ultrasound during diagnostic laparoscopy for proximal biliary cancers: a single series of 100 patients. Surg Endosc 30, 1212–1218 (2016). https://doi.org/10.1007/s00464-015-4333-4

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  • DOI: https://doi.org/10.1007/s00464-015-4333-4

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