Abstracts
1997 Digestive Disease Week

Laparoscopy and laparoscopic ultrasonography avoids exploratory laparotomy in patients with hepatocellular carcinoma.

CM Lo, ECS Lai, CL Liu, ST Fan, J Wong. Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong.

This prospective study evaluated the value of laparoscopy and laparoscopic ultrasonography (USG) in -patients with potentially resectable hepatocellular carcinoma (HCC). Between June 1994 and June 1996, 110 of 370 patients with HCC seen at one institution were considered suitable for hepatic resection after a standard series of preoperative studies. Liver function was assessed using Child-Pugh grading and indocyanine green retention test. The extent of disease was evaluated with imaging studies including percutaneous USG, computerised tomography (CT), and hepatic arteriogram with or without Lipiodol-CT scan. Nineteen patients were excluded from the study and underwent laparotomy directly because of previous upper abdominal surgery (n=12), recent tumour ruture (n=4), patient refusal (n=2), and instrument failure (n=1). Laparoscopy and laparoscopic ultrasonography was performed in 91 patients (male/female : 77/14; mean age 53.2 yrs) immediately before a planned laparotomy aiming at hepatic resection. Laparoscopy and laparoscopic USG demonstrated evidence of unresectable disease, and thus avoided laparotomy in 15 patients (group A). Among the remaining 76 patients who underwent laparotomy, 9 had exploration only (group B) and 67 underwent hepatic resection (group C). Thus, the use of laparoscopy and laparoscopic USG avoided exploratory laparotomy in 63% of patients with unresectable disease and increased the resectability rate from 74% to 88%. The median (range) time required for laparoscopic examination was 45 (30-120) mins, 20 (15-35) mins and 25 (10-90) mins for groups A, B and C respectively (p<0.001, group A Vs B or C). Patients with unresectable disease detected by laparoscopy and laparoscopic USG had a smaller tumour size than those found only at laparotomy (8 cm Vs 11.6 cm, p=0.06). When unresectable disease was detected by laparoscopy and laparoscopic USG without the need for laparotomy, patients had a shorter hospital stay (median 5 days Vs 9 days, p<0.005) and could receive nonoperative treatment for the tumour at a shorter interval after surgery (median 6 days Vs 23 days, p<0.05). We conclude that laparoscopy and laparoscopic USG can avoid unnecessary exploratory laparotomy in patients with HCC. Its value may be limited in patients with large tumours.