Laparoscopy with laparoscopic ultrasound for pretreatment staging of hepatic focal lesions: a prospective study

The need for accurate intrahepatic staging is crucial for patients with primary or secondary hepatic malignancies. Currently available data indicate that laparoscopy with laparoscopic ultrasound provides information similar to that obtained by intraoperative ultrasound and that it is able to identify small intrahepatic lesions not diagnosed by preoperative conventional imaging techniques.

To determine the role of preoperative laparoscopy and laparoscopic ultrasonography in patients with potentially resectable hepatic focal lesion or candidate for radiofrequency ablation based on preoperative imaging.

From March 2004 to March 2007, 55 patients with potentially resectable hepatic focal lesions were candidates for exploratory laparotomy based on preoperative abdominal ultrasonography and triphasic spiral CT. All cases were then reevaluated prior to surgery using laparoscopy and laparoscopic ultrasound. All these procedures were performed within a time period of no more than 4 weeks. The data obtained were compared to those obtained by the preoperative conventional imaging studies as regards the presence of satellites, subcentimetric lesions, newly discovered deep parynchymatous lesions, liver condition, portal vein thrombosis, nodal metastases, ascites, peritoneal implants, size and site of the primary lesion.

After performing ultrasound-guided laparoscopy, fourteen patients proved to be unfit for surgical resection or ablation, seven patients showed newly discovered focal lesions, five patients proved to have satellites around the tumor and peritoneal deposits, one patient had ascites and one patient had been falsely diagnosed as HCC, proved to have had a liver abscess.

Preoperative laparoscopy and laparoscopic ultrasonography as an adjunct to preoperative imaging techniques provide more accurate staging for patients with potentially resectable hepatic focal lesions.