Routine staging laparoscopy has no place in the management of colorectal liver metastases

Eur J Surg Oncol. 2013 Jul;39(7):721-5. doi: 10.1016/j.ejso.2013.03.024. Epub 2013 Apr 22.

Abstract

Aims: Staging laparoscopy has been recommended in the management of patients with colorectal liver metastases prior to hepatectomy in order to reduce the incidence and associated morbidity of futile laparotomies. The utility of staging laparoscopy has not been assessed in patients undergoing CT, PET-CT and MRI as standard preoperative staging.

Methods: All patients undergoing attempted open hepatectomy for colorectal liver metastases between 1/4/2008 and 31/3/2012 were identified from a prospectively maintained research database. All patients who underwent futile laparotomy were identified, with demographics and operative notes subsequently analysed.

Results: A total of 274 patients underwent attempted open hepatectomy during the study period. At laparotomy 12 (4.4%) patients were found to have irresectable disease. There were no unifying demographic factors within the patients undergoing futile laparotomy.

Conclusions: With modern imaging, the potential yield of staging laparoscopy is low. Staging laparoscopy should not be used routinely, but may have a role in the case of specific clinical concerns.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cohort Studies
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / surgery
  • Databases, Factual
  • Diagnostic Tests, Routine
  • Disease-Free Survival
  • Female
  • Hepatectomy / methods*
  • Hepatectomy / mortality
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Laparotomy / methods
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / secondary*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging / adverse effects
  • Neoplasm Staging / methods*
  • Positron-Emission Tomography
  • Preoperative Care / methods
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Survival Analysis
  • Tomography, X-Ray Computed