Staging Laparoscopy for Assessing Inoperability in Gastrointestinal Malignancies: Is it Useful?

Medical Journal of Dr. D.Y. Patil Vidyapeeth

article

Sondhi, Manish K.¹  Gupta, Samir K.¹  Bhalla, Alok J.¹  Kulkarni, Shrirang Vasant² 

[1] Department of Surgery, Command Hospital;Department of GI Surgery and Liver Transplantation, Army Hospital Research and Referral;Department of Surgical Oncology, Dr. D. Y. Patil Medical College, Hospital and Research Center;Department of GI Surgery, Command Hospital

关键词: Intra-abdominal gastrointestinal malignancies;    Staging laparoscopy;    Inoperability;   

DOI  :  10.4103/mjdrdypu.mjdrdypu_23_21

学科分类：社会科学、人文和艺术（综合）

来源: Wolters Kluwer Medknow Publications

【 摘 要 】

Background:  Despite the availability of modern cross-sectional diagnostic staging modalities, preoperative assessment of operability in intra-abdominal malignancy is often inadequate, especially in patients being considered for potential curative resection, resulting in many unnecessary laparotomies. Staging laparoscopy (SL) is usually undertaken in tertiary care centers, but the same has not been widely studied in India. The aim of the present study was to find out the possibility of diagnosing inoperability on SL and to study whether SL can prevent unnecessary laparotomy in cases of clinically diagnosed potentially resectable abdominal malignancies. Methods:  This prospective diagnostics study was conducted in consecutive patients with gastrointestinal malignancies. All eligible patients were subjected to a thorough SL to look for inoperability before a therapeutic laparotomy. Statistical analysis of SL as a diagnostic modality was performed and the results were noted. Results:  A total of 88 such patients were studied. The SL demonstrated inoperability in 24 out of the 88 (27.3%) patients. However, it failed to predict inoperability in 11 (12.5%) patients, yielding a sensitivity of 68.57% and specificity of 100%. The positive predictive value (PPV) of SL was 100%, whereas the negative predictive value (NPV) was 82.81% with efficacy of 87.5%. Conclusions:  The specificity, PPV, NPV, and accuracy of SL to rule out inoperability in clinically diagnosed potentially resectable intra-abdominal gastrointestinal malignancies are noteworthy. The sensitivity of SL for the same purpose, though relatively low, may be augmented with practices such as liberal use of frozen section biopsy and intraoperative ultrasound. However, SL still fails to demonstrate unresectability due to locoregional advancement and aortocaval lymph node mets.

【 授权许可】

CC BY-NC-SA