Laparoscopy for Assessing Hepatic Metastasis

Researchers have reported that laparoscopy with intraoperative ultrasound is a valuable method of evaluating and managing isolated hepatic metastasis from colorectal cancer by identifying inoperable patients and by treating patients without laparotomy.

Laparoscopic assessment of the liver can be an important staging and treatment method for the management of patients with colorectal cancer patients with apparent isolated metastases to the liver.

The investigators, from the departments of hepatobiliary and pancreatic surgery and minimally invasive surgery, Legacy Health System (Portland, OR, USA), tried to determine the specific benefit of laparoscopy when combined with intraoperative ultrasound in the assessment and treatment of 152 patients who had isolated hepatic metastasis as determined by computed tomography (CT) and by positron emission tomography (PET), which was conducted in 70% of the cases.

The researchers discovered surgically untreatable disease in 25% of patients because of peritoneal metastasis, nodal involvement, diffuse hepatic disease, or untreatable disease. Furthermore, two patients had no identifiable disease at laparoscopy. Laparoscopic treatment included radiofrequency ablations, hepatic artery implantations, resections, and combined procedures. The researchers reported that laparoscopy with intraoperative sonography altered the treatment plans of about 50% of patients in relation to preoperative plans. Complication rates were seen in just three patients who had a median hospital stay of one day. The study also showed that many patients with isolated hepatic metastasis can be treated without the invasiveness of a laparotomy procedure.

The study was published in the August 8, 2005, issue of the journal Archives of Surgery.




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