Abstracts
1999 Digestive Disease Week

# 3472 PROSPECTIVE EVALUATION OF LAPAROSCOPY IN PATIENTS WITH HEPATOBILIARY MALIGNANCIES
William R Jarnagin, L H Blumgart, K Conlon, J Bodniewicz, Yuman Fong, Memorial Sloan-Kettering Cancer Ctr, New York, NY

Preoperative staging laparoscopy and laparoscopic ultrasound (LUS) are widely used in cancer patients. However, in patients with hepatobiliary malignancies, a prospective comparison to 'no laparoscopy' has not been done. METHODS: Over a 10 month period (11/97-9/98), 186 patients with 1o and 2o hepatobiliary malignancies were submitted to operation for potentially curative resection; patients with pancreatic or periampullary tumors or a previous liver resection were excluded. 104 patients underwent laparoscopy (LAP) before laparotomy (93 with LUS); 82 were explored without laparoscopy (NO LAP). Operative findings, hospital days, OR time, hospital charges, and resectability were analyzed. RESULTS: Demographic data and diagnoses were similar in the 2 groups. Laparoscopy revealed additional findings in 40 patients (38%), 26 of whom were deemed irresectable; 9 of these patients underwent alternative procedures while 17 were spared a laparotomy. Laparoscopy identified 26 of 39 (67%) irresectable patients. LUS provided additional information in 10 patients (11%), 7 of whom were resected despite the new findings. The proportion of irresectable patients identified laparoscopically was not significantly affected by the diagnosis (2o tumors 72% vs. 1o tumors 62%, p=0.5), location of the finding (liver 70% vs. extrahepatic 59%, p=0.4), or prior abdominal surgery (63% vs. 70%, p=0.7). However, the overall impact of laparoscopy in reducing hospital days and total charges and improving resectability was greater in patients with 1o tumors (hepatocellular and GB carcinoma, hilar and intrahepatic cholangiocarcinoma) versus those with 2o tumors. CONCLUSION: Staging laparoscopy identified the majority of patients with irresectable hepatobiliary malignancies, significantly improved resectability, and reduced hospital days and total charges. Irresectable patients identified laparoscopically had an average of 6 fewer hospital days and nearly 50% lower hospital charges. Laparoscopic identification of irresectable disease was not affected by the diagnosis, location of the finding or prior abdominal surgery; however, the benefits of laparoscopy were greater in patients with 1o tumors. LUS added little additional information.

ALL PATIENTS				IRRESECTABLE PATIENTS**
	LAP (n=104)	NO LAP	(n=82)	LAP (n=17)	NO LAP	(n=19)
OR TIME (min)	246±125	184±87	p=.0001	83±22	91±33	p= .4
Hospital Days	8.6±6.6	11.9±8.7,	p=.004	2.2±2	8.5±8.6,	p=.006
Total Charges*	.3±14.8	.5±23.8,	p=.004	.6±9.7	.4±20,	p= .05
Resectability	83%	66%,	p=.01	-	-
*-thousands of dollars
**-no additional procedures performed

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