Abstracts
2000 Digestive Disease Week

# 2274 Laparoscopy with Laparoscopic Ultrasound (L-LUS) for Pre-Treatment Staging of Hepatocellular Carcinoma: A Prospective Study.
Marco Montorsi, Roberto Santambrogio, Paolo Bianchi, Enrico Opocher, Silvia Vellini, Luigi Bonavina, Massimo Zuin, Mauro Podda, Milan, Italy

L+LUS proved to be superior to conventional CT imaging in the staging of hepatocellular carcinoma (HCC). Aim of our prospective study was to evaluate the efficacy of L+LUS when compared to the best available imaging (spiral CT or lipiodol CT) in patients with HCC. From January 1998 to September 1999, 51 consecutive patients (36 males and 15 females; mean age 66.5 + 7,1 years) were enrolled. Preoperative diagnostic work-up included: 51 liver ultrasound, 17 CT after lipiodol arteriography, 33 spiral CT and 1 NMR. A single lesion was found in 27 patients, two lesions in 15 patients and three lesions in 9 patients. Liver cirrhosis was related to chronic HCV infection in 42, to HBV infection in 5 and to alcohol abuse in 4 patients. Liver function was classified as Child’s A in 35 pts. and Child’s B in 16. L-LUS was performed in all patients under general anaesthesia with a 2/3-trocars technique. The imaging unit was an Aloka SSD 500 (Aloka Co. Ltd., Tokyo, Japan) with a rigid ultrasound probe with a 7.5 MHz linear array transducer. The examination was completed in 49 patients (96%): in 2 cases extensive adhesions prevented the L-LUS examination. Mean time required for L+LUS and related-treatments was 67 min. (range: 15 to 120 min.). Pathologic diagnosis (16 or 18 G cutting needle) was obtained in all cases. There were 5 (10%) minor LUS-related complications (subcutaneous hematoma at the trocar site). L-LUS confirmed the diagnosis of HCC in 44 cases while a different histologic diagnosis was obtained in 5 pts (2 cholangiocarcinoma, 3 macronodule). Moreover L-LUS yielded new information in 29 patients: 9 additional malignant nodules (18%) (8 primary intra-hepatic HCC and 1 right adrenal metastasis), 18 benign focal liver lesions (37%) and 2 changes in topography of the lesion (4%). Additional malignant nodules were detected more frequently if the patient had more than one main lesion (33% vs. 11%; p<0.05). No additional malignant nodules were found if the main lesion diameter was less than 30 mm. In our preliminary experience, LUS was a safe and reliable procedure. It allowed to obtain superior information (intraoperative histologic confirmation)Êfor the diagnosis and pre-treatment staging of HCC in patients with cirrhosis when compared to actual radiologic imaging.