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分期腹腔镜检查在胰周和肝胆恶性肿瘤中的作用。

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy.

机构信息

Sebastien Gaujoux, Peter J Allen, Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C-887, New York, NY 10021, United States.

出版信息

World J Gastrointest Surg. 2010 Sep 27;2(9):283-90. doi: 10.4240/wjgs.v2.i9.283.

Abstract

Even after extensive preoperative assessment, staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease. Staging laparoscopy is associated with decreased postoperative pain, a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques. Current uses of staging laparoscopy include the following: (1) In the staging of pancreatic adenocarcinoma, laparoscopic staging allows for the identification of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and, in radiographically resectable cancer, may identify metastatic disease in 10%-15% of cases; (2) In colorectal liver metastases, selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients; (3) In hepatocellular carcinoma, laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors; and (4) In biliary tract malignancy, staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma. Because of the decreasing yield of SL secondary to improvements in imaging techniques, staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization. Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.

摘要

即使经过广泛的术前评估,分期腹腔镜检查也可能使影像学隐匿性转移性或局部不可切除疾病患者避免不必要的剖腹探查。与剖腹探查相比,分期腹腔镜检查与术后疼痛减轻、住院时间缩短和更有可能接受全身治疗相关,但随着影像学技术的改进,其检出率有所下降。分期腹腔镜检查的目前用途包括以下几个方面:(1)在胰腺腺癌分期中,腹腔镜分期可在局部晚期癌症中约 30%的患者中识别出亚影像学转移性疾病,在影像学可切除的癌症中,可能在 10%-15%的病例中识别出转移性疾病;(2)在结直肠癌肝转移中,对临床风险评分超过 2 的患者选择性使用腹腔镜分期可识别出约 20%的不可切除疾病;(3)在肝细胞癌中,腹腔镜分期可选择性用于高危患者,如临床明显肝硬化患者以及存在大血管侵犯或双侧肿瘤的患者;(4)在胆道恶性肿瘤中,分期腹腔镜检查可用于所有具有潜在可切除原发性胆囊癌的患者,以及选择性用于 T2/T3 肝门部胆管癌的患者。由于影像学技术的改进导致 SL 检出率降低,因此应选择性地对胰腺和肝胆恶性肿瘤患者进行分期腹腔镜检查,以避免不必要的非治疗性剖腹探查,并提高资源利用率。每位外科医生都应根据术前影像学研究的质量和所在机构的资源可用性,自行设定是否进行分期腹腔镜检查的阈值。

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