Abstracts
2001 Digestive Disease Week

# 479 The Additional Value of Diagnostic Laparoscopy in the Work-up of Patients with a Proximal Bile Duct Tumor
Esther H.B.M. Tilleman, Steve M.M. Castro de, Olivier R.C. Busch, Thomas M.M. Gulik van, Huug Obertop, Dirk J. Gouma, Amsterdam, Netherlands

Tumor staging in patients with a proximal bile duct tumor is focussed on selecting patients who might benefit from a tumor resection. Diagnostic laparoscopy has proven its value in GI malignancies. Small superficial liver and peritoneal metastasis can be visualized and punctured under direct view. Since 1993 diagnostic laparoscopy is used routinely in the diagnostic work-up of patients with a proximal bile duct tumor. Initial results of a pilot study seemed to be promising but because of limited data in literature, regarding the additional value of diagnostic laparoscopy in the staging of proximal bile duct tumors, we decided to extend our study. Between January 1993 and May 2000 diagnostic laparoscopy was performed in 106 patients (59 male and 47 female patients, with a mean age of 59 year (range 30-80)) with a resectable proximal bile duct tumor after radiological staging (US, Doppler, CT, ERCP, PTC). During laparoscopy 41 of the 106 patients (39%) had incurable disease (36 metastasis and 5 extensive tumor ingrowth) which could be proven histologically. In these patients laparotomy was prevented as they were already palliated endoscopically. The 65 patients staged as having a resectable tumor underwent a laparotomy for tumor resection. Twenty-eight of them (26% of the initial 106 patients) turned out to have an unresectable tumor at laparotomy (8 metastasis, 13 tumor ingrowth in surrounding tissues, 5 encasement of veins/arteries and 2 lymph node metastasis). Sensitivity of diagnostic laparoscopy for detecting metastases in patients with a proximal bile duct tumor is 84%, the negative predictive value is 87%.

Conclusion: Diagnostic laparoscopy could prevent an unnecessary laparotomy in 39% of the patients with a proximal bile duct tumor. Therefore this procedure is beneficial in the diagnostic work-up and should be used routinely. However, improvement could be obtained, as during laparotomy in another 8% of the patients metastases were found.