Background: Despite radiographic advances, disparities exist between preoperative imaging studies and intraoperative findings.This study compared the accuracy of diagnostic laparoscopy (DL) and laparoscopic ultrasonography (LUS) with that of spiral CT scan, MRI, ultrasonography and PET scan in assessing the extent and resectability of abdominal neoplasms.
Methods: DL/LUS using a 7.5-Mhz ultrasound probe was undertaken in 70 consecutive patients with abdominal neoplasms. All patients had spiral CT scan with oral and IV contrast within 2 months of surgery. Additional imaging studies were obtained if CT scan findings were equivocal.
Results: The 43 males and 27 females had a mean age of 63 years (range, 35-87 years). The most frequent primary neoplasms were colorectal carcinoma (23), hepatoma (14), and melanoma (13). DL identified peritoneal metastatic implants not diagnosed by preoperative imaging in 12 cases (17%). In 22 cases (31%) there were discrepancies between LUS and preoperative imaging (vascular invasion in 1, size of metastsis in 3, number of metastasis in 6, location in 3, type of lesion in 4, and more than one variable in 5 cases). The findings of DL/LUS altered surgical treatment in 26 cases (37%).
Conclusions: This is the largest reported series of DL/LUS for intraabdominal neoplasms. When compared with preoperative imaging studies, the combination of DL and LUS is more sensitive and specific in staging intraabdominal neoplasms and effectively reduces the number of unnencessary laparotomies. DL/LUS should be routinely used in all patients with intraabdominal neoplasms who are candidates for surgical exploration.