Staging laparoscopy with para-aortic lymph node sampling for biliary tract cancer
Kokoro Niwa1, Kimitaka Tanaka1, Shintaro Takeuchi1
1Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Surgical Oncology
|August 14, 2026
Summary
Staging laparoscopy with para-aortic lymph node sampling is a safe and feasible approach for biliary tract cancer. This method detects distant metastases, preventing unnecessary surgeries and enabling prompt chemotherapy initiation.
Area of Science:
- Oncology
- Surgical Oncology
- Diagnostic Laparoscopy
Background:
- Biliary tract cancer (BTC) often presents at advanced stages, with para-aortic lymph node (PALN) metastasis indicating distant disease.
- Occult PALN metastasis on imaging leads to futile surgeries upon laparotomy.
- Staging laparoscopy (SL) with PALN sampling offers a potential solution for accurate staging.
Purpose of the Study:
- To evaluate the feasibility and clinical impact of staging laparoscopy (SL) for biliary tract cancer (BTC).
- To assess the utility of SL in detecting occult distant metastases, specifically PALN metastasis.
- To determine if SL can prevent unnecessary surgical interventions in BTC patients.
Main Methods:
- Retrospective single-center study of 23 BTC patients undergoing SL.
- SL included peritoneal washing cytology, peritoneal dissemination assessment, and PALN sampling for histology.
- Treatment strategy (curative surgery vs. chemotherapy) was determined based on SL findings.
Main Results:
- PALN metastasis detected in 26.1% of patients; peritoneal dissemination in 4.3%.
- Overall, 30.4% of patients avoided unnecessary laparotomies.
- One patient (4.3%) experienced a grade IIIa complication (lymphatic leakage); median operative time was 104 minutes.
Conclusions:
- Staging laparoscopy with PALN sampling is feasible and safe for BTC staging.
- SL effectively detects distant metastases, preventing futile laparotomies.
- SL facilitates timely transition to systemic therapy for advanced BTC.
