Staging Laparoscopy in 111 Intra-Hepatic and Hilar Cholangiocarcinoma Patients; A Tertiary U.K. Referral Centre Experience

Nicholas T.E. Bird, Mr, Mohamed Elmasry, Mr, Robert Jones, Mr, Declan Dunne, Michael Kelly, Dr, Johnathan Evans, Mr, Graeme Poston, Professor, Stephen Fenwick, MD, Hassan Malik, MD. University Hospital Aintree

AIMS: Staging laparoscopy is part of the routine management of cholangiocarcinoma for determining if there is occult intra-abdominal metastatic disease not discernible on cross-sectional imaging. The aim was to determine the utility of staging laparoscopy in the largest retrospectively assessed British cohort of hilar and intra-hepatic cholangiocarcinoma patients resected at a large U.K. tertiary Hepato-Biliary centre.

 METHODS: A database of 111 cholangiocarcinoma patients undergoing staging laparoscopy over an 8 year period from May 2007 to June 2015 was retrospectively analysed. The efficacy of staging laparoscopy in terms of Yield, Positive-Predictive-Value, False-Discovery-Rate and Specificity of the test was then calculated.

RESULTS:

  LAPAROSCOPED EXPLORATORY LAPAROTOMY
N (TOTAL) 111 80
MALE:FEMALE 63;48 47;33
DISEASE PRECLUDES FURTHER SURGERY 30 16
PERITONEAL METASTASES 15 11
INTRA-HEPATIC METS 2 6
LOCALLY ADVANCED 6 8
POOR LIVER QUALITY 4 0
RESECTION 0 64
YIELD PRECLUDING FURTHER SURGERY 27% (30/111) 20% (16/80)

The Positive-Predictive-Value of laparoscopy was 80% (64/80).

The False-Discovery-Rate (1-PPV) was 20%.

The Specificity of laparoscopy was 65.2 % (30/46).

42.3% of patients with laparoscopically occult peritoneal metastases proceeded to laparotomy.

47/64 (73.4%) resections had cholangiocarcinoma; 14/64 (21.9%) benign disease; 3/64 (4.7%) other tumours of which 2/64 (3.13%) were neuroendocrine and 1/64 (1.6%) were hepatocellular in origin.

CONCLUSIONS: The high Positive-Predictive-Value of 80% indicates that staging laparoscopy is highly precise in confirming radiologically resectable intra-hepatic and hilar cholangiocarcinoma.

However, the relatively low Specificity of the test of 65.2% indicates that in borderline resectable cases laparoscopy’s utility is more limited.

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