Staging laparoscopy with para-aortic lymph node sampling for biliary tract cancer

Biliary tract cancer (BTC) is often diagnosed at an advanced stage. Para-aortic lymph node (PALN) metastasis represents distant disease and contraindicates curative resection. It is frequently occult on preoperative imaging and identified only at laparotomy, resulting in futile surgery. PALN sampling during staging laparoscopy (SL) may therefore be useful. We evaluated the feasibility and clinical impact of SL for BTC.

This retrospective single-centre study included 23 patients with perihilar or intrahepatic cholangiocarcinoma or gallbladder cancer without distant metastases on imaging who underwent SL between March 2024 and August 2025. SL was performed in patients requiring vascular resection, hepatopancreatoduodenectomy (HPD), or major hepatectomy with planned preoperative portal vein embolisation (PTPE), and in those before or during neoadjuvant therapy. Based on SL findings, treatment strategy was determined as curative surgery or systemic chemotherapy. SL included peritoneal washing cytology, assessment of peritoneal dissemination, and PALN sampling for permanent histology.

Twenty-three patients underwent SL. PALN metastasis was detected in six patients (26.1%) and peritoneal dissemination in one (4.3%). Overall, seven patients (30.4%) avoided unnecessary laparotomies. One patient (4.3%) developed a Clavien-Dindo grade IIIa complication due to lymphatic leakage. Median operative time was 104 min (range, 61-151 min). Among patients with distant metastases detected on SL, the median time to chemotherapy initiation was 32 days (range, 14-60 days).

SL with PALN sampling is feasible and safe for BTC, enabling the detection of distant metastases, and avoiding futile laparotomy, and facilitating a timely transition to systemic therapy.