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- PMID: 9563541
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Article: Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma
Title | Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma |
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Authors | |
Issue Date | 1998 |
Publisher | Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com |
Citation | Annals Of Surgery, 1998, v. 227 n. 4, p. 527-532 How to Cite? |
Abstract | Objective: This prospective study evaluates the value of laparoscopy and laparoscopic ultrasonography (USG) in avoiding exploratory laparotomy in patients with hepatocellular carcinoma (HCC). Summary Background Data: Laparotomy and intraoperative USG is the gold standard to determine the resectability of HCC. No palliation can be offered to patients found to have unresectable disease, and the surgical exploration causes morbidity. Methods: From June 1994 to June 1996, 110 of 370 patients (30%) with HCC were considered candidates for possible hepatic resection. Preoperative liver function was assessed using Child-Pugh grading and indocyanine green retention test. The extent of disease was evaluated with radiologic studies, including percutaneous USG, computerized tomography scan, and hepatic angiogram. Nineteen patients were excluded from the study because of previous upper abdominal surgery (n = 12), ruptured tumors (n = 4), refusal by patients (n = 2), and instrument failure (n = 1). Laparoscopy and laparoscopic USG was performed on 91 patients immediately before a planned laparotomy aiming at hepatic resection. Laparotomy was aborted when definite evidence of unresectable disease was found on laparoscopic examination. Results: The median time required for laparoscopy and laparoscopic USG was 30 minutes (range, 10 to 120 minutes). Fifteen patients had evidence of unresectable disease on laparoscopic examination. Among the remaining 76 patients who underwent laparotomy, 9 had exploration only and 67 underwent hepatic resection. Thus, exploratory laparotomy was avoided in 63% of patients with unresectable disease. The laparoscopic examination failed to confirm unresectable disease more often when the tumor was >10 cm in diameter. The procedure accurately assessed the adequacy of the liver remnant and the presence of intrahepatic metastases, but it was less sensitive in determining the presence of tumor thrombi in major vascular structures and the extent of invasion of adjacent organs. When unresectable disease was detected without the need for a laparotomy, the postoperative recovery was faster, and the nonoperative treatment for the tumor could be initiated earlier. Conclusions: Laparoscopy with laparoscopic USG avoids unnecessary laparotomy in patients with HCC and should precede a planned laparotomy aiming at hepatic resection. |
Persistent Identifier | http://hdl.handle.net/10722/172744 |
ISSN | 2023 Impact Factor: 7.5 2023 SCImago Journal Rankings: 2.729 |
ISI Accession Number ID | |
References |
DC Field | Value | Language |
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dc.contributor.author | Lo, CM | en_HK |
dc.contributor.author | Lai, ECS | en_HK |
dc.contributor.author | Liu, CL | en_HK |
dc.contributor.author | Fan, ST | en_HK |
dc.contributor.author | Wong, J | en_HK |
dc.date.accessioned | 2012-10-30T06:24:38Z | - |
dc.date.available | 2012-10-30T06:24:38Z | - |
dc.date.issued | 1998 | en_HK |
dc.identifier.citation | Annals Of Surgery, 1998, v. 227 n. 4, p. 527-532 | en_HK |
dc.identifier.issn | 0003-4932 | en_HK |
dc.identifier.uri | http://hdl.handle.net/10722/172744 | - |
dc.description.abstract | Objective: This prospective study evaluates the value of laparoscopy and laparoscopic ultrasonography (USG) in avoiding exploratory laparotomy in patients with hepatocellular carcinoma (HCC). Summary Background Data: Laparotomy and intraoperative USG is the gold standard to determine the resectability of HCC. No palliation can be offered to patients found to have unresectable disease, and the surgical exploration causes morbidity. Methods: From June 1994 to June 1996, 110 of 370 patients (30%) with HCC were considered candidates for possible hepatic resection. Preoperative liver function was assessed using Child-Pugh grading and indocyanine green retention test. The extent of disease was evaluated with radiologic studies, including percutaneous USG, computerized tomography scan, and hepatic angiogram. Nineteen patients were excluded from the study because of previous upper abdominal surgery (n = 12), ruptured tumors (n = 4), refusal by patients (n = 2), and instrument failure (n = 1). Laparoscopy and laparoscopic USG was performed on 91 patients immediately before a planned laparotomy aiming at hepatic resection. Laparotomy was aborted when definite evidence of unresectable disease was found on laparoscopic examination. Results: The median time required for laparoscopy and laparoscopic USG was 30 minutes (range, 10 to 120 minutes). Fifteen patients had evidence of unresectable disease on laparoscopic examination. Among the remaining 76 patients who underwent laparotomy, 9 had exploration only and 67 underwent hepatic resection. Thus, exploratory laparotomy was avoided in 63% of patients with unresectable disease. The laparoscopic examination failed to confirm unresectable disease more often when the tumor was >10 cm in diameter. The procedure accurately assessed the adequacy of the liver remnant and the presence of intrahepatic metastases, but it was less sensitive in determining the presence of tumor thrombi in major vascular structures and the extent of invasion of adjacent organs. When unresectable disease was detected without the need for a laparotomy, the postoperative recovery was faster, and the nonoperative treatment for the tumor could be initiated earlier. Conclusions: Laparoscopy with laparoscopic USG avoids unnecessary laparotomy in patients with HCC and should precede a planned laparotomy aiming at hepatic resection. | en_HK |
dc.language | eng | en_US |
dc.publisher | Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com | en_HK |
dc.relation.ispartof | Annals of Surgery | en_HK |
dc.rights | Annals of Surgery. Copyright © Lippincott Williams & Wilkins. | - |
dc.subject.mesh | Adolescent | en_US |
dc.subject.mesh | Adult | en_US |
dc.subject.mesh | Aged | en_US |
dc.subject.mesh | Aged, 80 And Over | en_US |
dc.subject.mesh | Carcinoma, Hepatocellular - Pathology - Surgery - Ultrasonography | en_US |
dc.subject.mesh | Female | en_US |
dc.subject.mesh | Humans | en_US |
dc.subject.mesh | Laparoscopy | en_US |
dc.subject.mesh | Laparotomy | en_US |
dc.subject.mesh | Liver - Surgery | en_US |
dc.subject.mesh | Liver Neoplasms - Pathology - Surgery - Ultrasonography | en_US |
dc.subject.mesh | Male | en_US |
dc.subject.mesh | Middle Aged | en_US |
dc.subject.mesh | Neoplasm Staging | en_US |
dc.subject.mesh | Prospective Studies | en_US |
dc.subject.mesh | Ultrasonography, Interventional | en_US |
dc.title | Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma | en_HK |
dc.type | Article | en_HK |
dc.identifier.email | Lo, CM: chungmlo@hkucc.hku.hk | en_HK |
dc.identifier.email | Fan, ST: stfan@hku.hk | en_HK |
dc.identifier.email | Wong, J: jwong@hkucc.hku.hk | en_HK |
dc.identifier.authority | Lo, CM=rp00412 | en_HK |
dc.identifier.authority | Fan, ST=rp00355 | en_HK |
dc.identifier.authority | Wong, J=rp00322 | en_HK |
dc.description.nature | link_to_subscribed_fulltext | en_US |
dc.identifier.doi | 10.1097/00000658-199804000-00013 | en_HK |
dc.identifier.pmid | 9563541 | - |
dc.identifier.scopus | eid_2-s2.0-0031904688 | en_HK |
dc.identifier.hkuros | 31302 | - |
dc.relation.references | http://www.scopus.com/mlt/select.url?eid=2-s2.0-0031904688&selection=ref&src=s&origin=recordpage | en_HK |
dc.identifier.volume | 227 | en_HK |
dc.identifier.issue | 4 | en_HK |
dc.identifier.spage | 527 | en_HK |
dc.identifier.epage | 532 | en_HK |
dc.identifier.isi | WOS:000073010600013 | - |
dc.publisher.place | United States | en_HK |
dc.identifier.scopusauthorid | Lo, CM=7401771672 | en_HK |
dc.identifier.scopusauthorid | Lai, ECS=36932159600 | en_HK |
dc.identifier.scopusauthorid | Liu, CL=7409789712 | en_HK |
dc.identifier.scopusauthorid | Fan, ST=7402678224 | en_HK |
dc.identifier.scopusauthorid | Wong, J=8049324500 | en_HK |
dc.identifier.issnl | 0003-4932 | - |