Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Apr;227(4):527–532. doi: 10.1097/00000658-199804000-00013

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

C M Lo 1, E C Lai 1, C L Liu 1, S T Fan 1, J Wong 1
PMCID: PMC1191308  PMID: 9563541

Abstract

OBJECTIVE: This prospective study evaluates the value of laparoscopy and laparoscopic ultrasonography (USG) in avoiding exploratory laparotomy in patients with hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: Laparotomy and intraoperative USG is the gold standard to determine the resectability of HCC. No palliation can be offered to patients found to have unresectable disease, and the surgical exploration causes morbidity. METHODS: From June 1994 to June 1996, 110 of 370 patients (30%) with HCC were considered candidates for possible hepatic resection. Preoperative liver function was assessed using Child-Pugh grading and indocyanine green retention test. The extent of disease was evaluated with radiologic studies, including percutaneous USG, computerized tomography scan, and hepatic angiogram. Nineteen patients were excluded from the study because of previous upper abdominal surgery (n = 12), ruptured tumors (n = 4), refusal by patients (n = 2), and instrument failure (n = 1). Laparoscopy and laparoscopic USG was performed on 91 patients immediately before a planned laparotomy aiming at hepatic resection. Laparotomy was aborted when definite evidence of unresectable disease was found on laparoscopic examination. RESULTS: The median time required for laparoscopy and laparoscopic USG was 30 minutes (range, 10 to 120 minutes). Fifteen patients had evidence of unresectable disease on laparoscopic examination. Among the remaining 76 patients who underwent laparotomy, 9 had exploration only and 67 underwent hepatic resection. Thus, exploratory laparotomy was avoided in 63% of patients with unresectable disease. The laparoscopic examination failed to confirm unresectable disease more often when the tumor was >10 cm in diameter. The procedure accurately assessed the adequacy of the liver remnant and the presence of intrahepatic metastases, but it was less sensitive in determining the presence of tumor thrombi in major vascular structures and the extent of invasion of adjacent organs. When unresectable disease was detected without the need for a laparotomy, the postoperative recovery was faster, and the nonoperative treatment for the tumor could be initiated earlier. CONCLUSIONS: Laparoscopy with laparoscopic USG avoids unnecessary laparotomy in patients with HCC and should precede a planned laparotomy aiming at hepatic resection.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Babineau T. J., Lewis W. D., Jenkins R. L., Bleday R., Steele G. D., Jr, Forse R. A. Role of staging laparoscopy in the treatment of hepatic malignancy. Am J Surg. 1994 Jan;167(1):151–155. doi: 10.1016/0002-9610(94)90066-3. [DOI] [PubMed] [Google Scholar]
  2. Bemelman W. A., de Wit L. T., van Delden O. M., Smits N. J., Obertop H., Rauws E. J., Gouma D. J. Diagnostic laparoscopy combined with laparoscopic ultrasonography in staging of cancer of the pancreatic head region. Br J Surg. 1995 Jun;82(6):820–824. doi: 10.1002/bjs.1800820633. [DOI] [PubMed] [Google Scholar]
  3. Bismuth H., Castaing D., Garden O. J. The use of operative ultrasound in surgery of primary liver tumors. World J Surg. 1987 Oct;11(5):610–614. doi: 10.1007/BF01655836. [DOI] [PubMed] [Google Scholar]
  4. Bismuth H., Houssin D., Ornowski J., Meriggi F. Liver resections in cirrhotic patients: a Western experience. World J Surg. 1986 Apr;10(2):311–317. doi: 10.1007/BF01658152. [DOI] [PubMed] [Google Scholar]
  5. Cozzi P. J., McCall J. L., Jorgensen J. O., Morris D. L. Laparoscopic vs open ultrasound of the liver: an in vitro study. HPB Surg. 1996;10(2):87–89. doi: 10.1155/1996/71637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fan S. T., Lai E. C., Lo C. M., Ng I. O., Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg. 1995 Feb;130(2):198–203. doi: 10.1001/archsurg.1995.01430020088017. [DOI] [PubMed] [Google Scholar]
  7. Fan S. T. Technique of hepatectomy. Br J Surg. 1996 Nov;83(11):1490–1491. doi: 10.1002/bjs.1800831103. [DOI] [PubMed] [Google Scholar]
  8. Feld R. I., Liu J. B., Nazarian L., Lev-Toaff A. S., Needleman L., Rawool N. M., Merton D. A., Segal S. R., Rosato F. E., Barbot D. J. Laparoscopic liver sonography: preliminary experience in liver metastases compared with CT portography. J Ultrasound Med. 1996 Apr;15(4):288–295. doi: 10.7863/jum.1996.15.4.288. [DOI] [PubMed] [Google Scholar]
  9. Gozzetti G., Mazziotti A., Cavallari A., Bellusci R., Bolondi L., Grigioni W., Bragaglia R., Grazi G. L., De Raffele E. Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis. Surg Gynecol Obstet. 1988 Jun;166(6):503–510. [PubMed] [Google Scholar]
  10. Jeng K. S., Chen B. F., Lin H. J. En bloc resection for extensive hepatocellular carcinoma: is it advisable? World J Surg. 1994 Nov-Dec;18(6):834–839. doi: 10.1007/BF00299079. [DOI] [PubMed] [Google Scholar]
  11. John T. G., Greig J. D., Carter D. C., Garden O. J. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg. 1995 Feb;221(2):156–164. doi: 10.1097/00000658-199502000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. John T. G., Greig J. D., Crosbie J. L., Miles W. F., Garden O. J. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg. 1994 Dec;220(6):711–719. doi: 10.1097/00000658-199412000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kanematsu T., Matsumata T., Takenaka K., Yoshida Y., Higashi H., Sugimachi K. Clinical management of recurrent hepatocellular carcinoma after primary resection. Br J Surg. 1988 Mar;75(3):203–206. doi: 10.1002/bjs.1800750305. [DOI] [PubMed] [Google Scholar]
  14. Lai E. C., Fan S. T., Lo C. M., Chu K. M., Liu C. L., Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg. 1995 Mar;221(3):291–298. doi: 10.1097/00000658-199503000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lee N. W., Wong J., Ong G. B. The surgical management of primary carcinoma of the liver. World J Surg. 1982 Jan;6(1):66–75. doi: 10.1007/BF01656375. [DOI] [PubMed] [Google Scholar]
  16. Makuuchi M., Hasegawa H., Yamazaki S., Takayasu K., Moriyama N. The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma. World J Surg. 1987 Oct;11(5):615–621. doi: 10.1007/BF01655837. [DOI] [PubMed] [Google Scholar]
  17. Makuuchi M., Takayama T., Kosuge T., Yamazaki S., Yamamoto J., Hasegawa H., Takayasu K. The value of ultrasonography for hepatic surgery. Hepatogastroenterology. 1991 Feb;38(1):64–70. [PubMed] [Google Scholar]
  18. Nagasue N., Kohno H., Chang Y. C., Taniura H., Yamanoi A., Uchida M., Kimoto T., Takemoto Y., Nakamura T., Yukaya H. Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg. 1993 Apr;217(4):375–384. doi: 10.1097/00000658-199304000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Nagasue N., Yukaya H. Liver resection for hepatocellular carcinoma: results from 150 consecutive patients. Cancer Chemother Pharmacol. 1989;23 (Suppl):S78–S82. doi: 10.1007/BF00647246. [DOI] [PubMed] [Google Scholar]
  20. Nieveen van Dijkum E. J., de Wit L. T., Obertop H., Gouma D. J. Port-site metastases following diagnostic laparoscopy. Br J Surg. 1996 Dec;83(12):1793–1794. doi: 10.1002/bjs.1800831242. [DOI] [PubMed] [Google Scholar]
  21. Okamoto E., Tanaka N., Yamanaka N., Toyosaka A. Results of surgical treatments of primary hepatocellular carcinoma: some aspects to improve long-term survival. World J Surg. 1984 Jun;8(3):360–366. doi: 10.1007/BF01655077. [DOI] [PubMed] [Google Scholar]
  22. Ozawa K., Takayasu T., Kumada K., Yamaoka Y., Tanaka K., Kobayashi N., Inamoto T., Shimahara Y., Mori K., Honda K. Experience with 225 hepatic resections for hepatocellular carcinoma over a 4-year period. Am J Surg. 1991 Jun;161(6):677–682. doi: 10.1016/0002-9610(91)91254-g. [DOI] [PubMed] [Google Scholar]
  23. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  24. Siriwardena A., Samarji W. N. Cutaneous tumour seeding from a previously undiagnosed pancreatic carcinoma after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1993 May;75(3):199–200. [PMC free article] [PubMed] [Google Scholar]
  25. Tang Z. Y., Uy Y. Q., Zhou X. D., Ma Z. C., Lu J. Z., Lin Z. Y., Liu K. D., Ye S. L., Yang B. H., Wang H. W. Cytoreduction and sequential resection for surgically verified unresectable hepatocellular carcinoma: evaluation with analysis of 72 patients. World J Surg. 1995 Nov-Dec;19(6):784–789. doi: 10.1007/BF00299771. [DOI] [PubMed] [Google Scholar]
  26. Wu C. C., Ho W. L., Yeh D. C., Huang C. R., Liu T. J., P'eng F. K. Hepatic resection of hepatocellular carcinoma in cirrhotic livers: is it unjustified in impaired liver function? Surgery. 1996 Jul;120(1):34–39. doi: 10.1016/s0039-6060(96)80238-8. [DOI] [PubMed] [Google Scholar]
  27. Yamanaka N., Okamoto E., Kuwata K., Tanaka N. A multiple regression equation for prediction of posthepatectomy liver failure. Ann Surg. 1984 Nov;200(5):658–663. doi: 10.1097/00000658-198411000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES