Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Ann Surg Oncol. 2011 Sep;18(9):2647-53. doi: 10.1245/s10434-011-1576-8. Epub 2011 Feb 23.
This study was designed to evaluate the benefit of staging laparoscopy (SL) in patients with suspected hilar cholangiocarcinoma (HCCA) during the past 10 years. Only 50-60% of patients with HCCA who undergo laparotomy are ultimately amenable to a potentially curative resection. In a previous study, we recommended routine use of SL to prevent unnecessary laparotomies. The accuracy of imaging techniques, however, has significantly improved during the past decade, which is likely to impact the yield and accuracy of SL.
From 2000 to 2010, 195 patients with suspected HCCA were analyzed. The yield and accuracy of SL were calculated by dividing total number of avoided laparotomies by the total number of laparoscopies or by all patients with unresectable disease, respectively. Factors associated with better yield and accuracy were assessed.
Of 195 patients with HCCA, 175 underwent SL. The yield of SL was 14% and the accuracy was 32%. Operative morbidity of SL was 3%, and operative morbidity of laparotomy for unresectable disease was 33%. No clear factors that influenced the yield of SL were found.
Overall yield and accuracy of SL for HCCA in the present series decreased to 14% and 32%, respectively, compared with earlier reports. This finding is likely the result of improved imaging techniques that evolved during the past decade. The place of SL in the workup of patients with HCCA needs to be reconsidered, and one should decide whether the declining additional value of SL still outweighs the drawbacks of SL.
本研究旨在评估过去 10 年中对疑似肝门部胆管癌（HCCA）患者进行分期腹腔镜检查（SL）的获益。仅 50-60%接受剖腹手术的 HCCA 患者最终可接受潜在治愈性切除。在之前的研究中，我们建议常规使用 SL 以防止不必要的剖腹手术。然而，过去十年中成像技术的准确性有了显著提高，这可能会影响 SL 的检出率和准确性。
从 2000 年到 2010 年，分析了 195 例疑似 HCCA 患者。通过将避免剖腹手术的总例数除以总腹腔镜例数或所有不可切除疾病患者数，计算 SL 的检出率和准确性。评估与更好的检出率和准确性相关的因素。
在 195 例 HCCA 患者中，175 例行 SL。SL 的检出率为 14%，准确性为 32%。SL 的手术发病率为 3%，不可切除疾病的剖腹手术发病率为 33%。未发现明显影响 SL 检出率的因素。
与早期报道相比，本研究中 SL 对 HCCA 的总体检出率和准确性分别降至 14%和 32%。这一发现可能是过去十年中成像技术不断发展的结果。在 HCCA 患者的检查中，SL 的位置需要重新考虑，人们应该判断 SL 不断下降的附加价值是否仍然超过 SL 的缺点。
