Evaluation of Effectiveness of Diagnostic Laparoscopy in Staging of Gastrointestinal and Hepatobiliary Malignancies: A Retrospective Study from a Tertiary Care Center
Citation Information :
Mishra B, Nayak J, Dalai P, Chawla A. Evaluation of Effectiveness of Diagnostic Laparoscopy in Staging of Gastrointestinal and Hepatobiliary Malignancies: A Retrospective Study from a Tertiary Care Center. World J Lap Surg 2023; 16 (2):71-74.
Objective: To evaluate the role of diagnostic laparoscopy for staging in gastrointestinal (GI) and hepatobiliary malignancies and to avoid unnecessary laparotomies.
Materials and methods: We conducted a retrospective review of the medical records of all patients admitted to the Department of General Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India from 2011 to 2021. The patients having abdominal malignancy were admitted to Surgery Department and following procedures undertaken that is history taking, clinical examination, routine examination, and special investigations. After initial assessment, they were subjected to laparoscopy.
Results: The study group had 30 cases (13 males and 17 females): 15 cases of stomach tumors; 13 cases of colorectal and 2 cases of biliary tract tumors. Laparoscopy could accomplish proper staging in 29 cases (96.7%) that is the sensitivity of staging laparoscopy is 0.97 and the specificity of the test is 1. Unnecessary and futile laparotomies were avoided in 13 patients (43.3%). Only 1 patient (3.3%) had to be subjected to laparotomy following staging laparoscopy and was found to be unresectable. Staging laparoscopy means duration in the resectable group was found to be 17.35 minutes which was lower than the mean duration in the unresectable group which is 20.76 minutes. There were no complications in 25 (83.7%) and only 5 (16.7%) had complications, in which 3 (10%) had operative wound sepsis, 2 (6.7%) had major respiratory complication. Staging laparoscopy was associated with decreased morbidity and pain, faster recovery and quicker initiation of adjuvant therapies.
Conclusion and interpretation: Staging laparoscopy has a very significant role in abdominal malignancies. It is very accurate in assessing peritoneal seedlings, and hepatic metastasis which are not found in imaging modalities. It is found to be more useful in staging gastric and extra-hepatic biliary tumors compared to colorectal cancers. It gives additional information regarding the extent of the disease intra-abdominally which changes the course of management in a significant number of patients. It has added benefit of performing biopsy from sites of dissemination and having histological confirmation. It spares malignancy patients from unnecessary laparotomies thereby decreasing hospital stay and cost expenditure when compared to open exploration.
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