Staging laparoscopy for hilar cholangiocarcinoma: is it still worthwhile?

This study was designed to evaluate the benefit of staging laparoscopy (SL) in patients with suspected hilar cholangiocarcinoma (HCCA) during the past 10 years. Only 50-60% of patients with HCCA who undergo laparotomy are ultimately amenable to a potentially curative resection. In a previous study, we recommended routine use of SL to prevent unnecessary laparotomies. The accuracy of imaging techniques, however, has significantly improved during the past decade, which is likely to impact the yield and accuracy of SL.

From 2000 to 2010, 195 patients with suspected HCCA were analyzed. The yield and accuracy of SL were calculated by dividing total number of avoided laparotomies by the total number of laparoscopies or by all patients with unresectable disease, respectively. Factors associated with better yield and accuracy were assessed.

Of 195 patients with HCCA, 175 underwent SL. The yield of SL was 14% and the accuracy was 32%. Operative morbidity of SL was 3%, and operative morbidity of laparotomy for unresectable disease was 33%. No clear factors that influenced the yield of SL were found.

Overall yield and accuracy of SL for HCCA in the present series decreased to 14% and 32%, respectively, compared with earlier reports. This finding is likely the result of improved imaging techniques that evolved during the past decade. The place of SL in the workup of patients with HCCA needs to be reconsidered, and one should decide whether the declining additional value of SL still outweighs the drawbacks of SL.