The Value of Diagnostic Laparoscopy for Assessment of Resectability in Hepatobiliary and Pancreatic Malignancy under the Local Anesthesia

Lee, Chang Seog; Cho, Chol Kyoon; Ghoo, Won Hoi; Kim, Hyun Jong

Abstract

BACKGROUNDS: Despite the advance of radiologic imaging techniques, not a fewer number of patients with hepatobiliary and pancreatic malignancies are found to be unresectable just at the time of laparotomy. The aim of this study was to evaluate the accuracy of diagnostic laparoscopy for assessing resectability of hepatobiliary and pancreatic malignancies.
METHODS
From May 1999 to March 2000, diagnostic laparoscopy was performed in 16 patients with suspected hepatobiliary and pancreatic malignancies after clinical examination, laboratory tests, and radiologic imaging techniques(ultrasonography, computed tomography, ERCP, and PTC). Local anesthesia with intravenous sedation was used. A 10-mm infraumbilical port was used for the telescope and another 5-mm port was used for the working instrument depending upon intra-abdominal findings. During the procedure, we tried to find any evidence of distant metastasis or advanced local invasion such as, peritoneal seeding, metastatic nodule at the liver, major vascular involvement or invasion of adjacent other intraabdominal organ.
RESULTS
4 of 16 patients were found to have unresectable malignancies because of peritoneal seeding, hepatic metastases or ascites by diagnostic laparoscopy. 3 patients had invasion to superior mesenteric vein and adjacent structures overlooked at diagnostic laparoscopy. Sensitivity, specificity, and overall accuracy for assessing resectability were 66.7%, 28.6% and 50.0% for radiologic imaging techniques and 100%, 57.1% and 81.3% for diagnostic laparoscopy.
CONCLUSION
Diagnostic laparoscopy under local anesthesia proved to be an effective diagnostic tool for assessing resectability of hepatobiliary and pancreatic malignancies by means of assisting the radiologic imaging technique.