Importance of Staging Laparoscopy in Upper Gastrointestinal and Hepatopancreatobiliary (Hpb) Malignancy.

Chaudhary JK*, Pokhrel S*, Adhikari SK**

Abstract


INTRODUCTION: Staging laparoscopy is gaining wide acceptance in gastrointestinal and hepatopancreatobiliary malignancy these days. It has the advantage of direct visualizaton of peritoneal cavity prior to formal laparotomy and hence can detect small peritoneal or pelvic deposit, liver metastasis and lymphnode metastasis which can prevent the case from noncurative definitive surgery. Palliative resection in advance malignancy is not justified in all cases as different minimally invasive palliative measures are available these days.

METHOD: All cases of radiologically resectable gastrointestinal and hepatopancreatobiliary malignancy underwent staging laparoscopy prior to formal laparotomy. Cases without metastasis in staging laparoscopy underwent definitive surgery and final histopathology result were compared with pre-operative radiological findings to assess the sensitivity and specificity of preoperative imaging and staging laparoscopy.

RESULT: Total 61 radiologically resectable cases of gastrointestinal and hepatopancreatobiliary malignancy were included in the study. Forty-six cases were found resectable in staging laparoscopy
out of that 40 cases had R0 resection. Fifteen (24.6%) cases found resectable in pre-operative imaging were found unresectable in staging laparoscopy. Sensitivity and specificity of CT- scan
was 48.8% and 70% whereas that of staging laparoscopy was 95.1% and 80% respectively.

CONCLUSION: Staging laparoscopy is simple accurate diagnostic test which can prevent patients with advance gastrointestinal and HPB malignancy from non-curative laparotomy.

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