[Is laparoscopic evaluation of digestive cancers legitimate? A prospective study of 109 cases]

Abstract

This aims of this study is to evaluate after laparoscopic exploration or treatment in digestive cancers, the incidence of port site metastases and the incidence of unnecessary laparotomy in advanced disease.

Patients: 109 patients were included in this study: 91 had localized digestive cancers and 18 had disseminated disease with hepatic and/or peritoneal metastases.

Methods: All the patients underwent a laparoscopy and a laparoscopic ultra-sonography under general anesthesia prior to a definitive decision on therapeutic management. Depending on the circumstances, histological or cytological biopsies were performed. The puncture sites of the trocar were examined clinically and, if required, by ultrasonography, monthly through out the course of the disease. Chemotherapy was instigated in 60.5 per cent of patients.

Results: 35 patients (32.1 per cent) only had one laparoscopic examination with a mean survival of 4.8 months, 22.9 per cent of patients had laparoscopic treatment of their lesion and 44.9 per cent had conventional treatment. Laparoscopic exploration allowed the detection of 52 lesions that had not been identified by conventional imaging techniques and thereby avoided 35 laparotomies (32.1 per cent). Tumor invasion of the peritoneum was present in 46 per cent of cases, most notably in the cases of pancreatico-biliary cancers. The overall mean survival was 32.7 months while it was 9.8 months in cases of palliative treatment. In total, 436 trocars were used. There was one case (0.9 per cent of patient or 0.02 per cent of port) of a metastasis occurring at the site of the trocar following treatment by right-sided, laparoscopic colectomy in a patient with disseminated cancer. Two factors seem to be involved peritoneal spread of the tumor and manipulation of the tumor.

Conclusions: Laparoscopic exploration for digestive cancers is a legitimate technique. It allows the detection of lesions that are not identified by conventional imaging techniques, permits a more accurate assessment of the resectability of a tumor and reduces the number of unnecessary laparotomies. The incidence of metastases at the site of the trocar is low and is closely linked to the presence of disseminated disease and manipulation of the tumor.