Staging of abdominal cancer by local anesthesia outpatient laparoscopy
Sand, J.; Marnela, K.; Airo, I.; Nordback, I.
Hepato-Gastroenterology 43(12): 1685-1688
1996
ISSN/ISBN: 0172-6390 PMID: 8975989 Document Number: 458365
Our aim was to review the results of one trocar staging laparoscopies performed under local anesthesia in outpatients with intra-abdominal cancer. Materials and Methods: Two hundred fifteen patients with intra-abdominal cancer (predominantly esophagogastric and pancreatohepatobiliary) underwent one trocar staging laparoscopy on lidocain infiltration anesthesia under conscious sedation. In 43 patients computed tomography (CT) or ultrasonography (US) had raised a suspicion of hepatic metastases, but percutaneous needle biopsy had failed to confirm it; 172 patients had negative CT or US. Peritoneum and liver were examined and biopsies were taken under direct laparoscopic control. Results: Fourteen patients (7%) received narcotics during the 2-6 hour observation. Mortality was zero. Complications occurred in 5 patients (2%): 1 small bowel perforation (operated), 1 bleeding from the abdominal wall, 1 acute atrial fibrillation, and 2 wound infections. In 79 patients histology demonstrated hepatic or peritoneal metastases. Out of 136 patients 123 were operated in whom laparoscopy did not demonstrate metastases. Thirty-eight of these were unresectable at laparotomy: Five patients (4%) had peritoneal or liver metastases and 33 (27%) proved locally inoperable. The sensitivity of laparoscopy to ascertain peritoneal or liver metastases was 94%. Conclusions: We conclude that one trocar local anesthesia outpatient laparoscopy is a fairly safe and effective method to detect peritoneal and liver metastases in abdominal cancer.