[The role of laparoscopy assessing the resectability of hepatic malignancies]

Regarding the prognosis of hepatic malignancies, surgical resection can provide a 40% 5-year survival, however liver transplantation (OLTX) shows even better results. Unfortunately, many patients have non-resectable disease due to either the number and the position of the tumours or its distant spread. It is relatively frequent that it turns out only at the time of the surgical exploration that the patient is inoperable. Hence, in addition to preoperative clinical evaluation and imaging, laparoscopy can be valuable in further staging and assessment of resectability in selected cases.

310 patients underwent hepatic resection between 1 January 2000 and 31 March 2006. A retrospective analysis was carried out of 39 patients, who underwent laparoscopy prior to the planned hepatectomy. 22 patients (56%) were diagnosed with hepatocellular carcinoma (HCC), while 17 patients (44%) had hepatic metastases.

Altogether 70% of the patients were found to have non-resectable tumour on laparoscopy. However, when these patients underwent laparotomy, non-resectable disease was found in 50% of them. Laparoscopy was helpful to demonstrate non-resectability of the tumour when carcinosis peritonei or multifocal lesions were present, but central or venous invasion could not be assessed adequately with this technique.

Laparoscopy can be an important component of the preoperative staging of malignant hepatic tumours. Further, it can help to avoid unnecessary laparotomies. However, this procedure is recommended in selected patients only, and its general use is not indicated.