Laparoscopic Staging of Abdominal Malignancies

Objectives: To assess the efficacy of laparoscopic evaluation of abdominal malignancies in terms of mortality, morbidity, sensitivity, specificity. Methods: A prospective randomized study on 62 patients affected by different malignant neoplasms whose tumor staging needed a confirmation by explorative laparotomy as requested from oncologists. Tumor histology was available in 22 cases of ovarian cancers previously treated and requiring a second look, in 12 operated pancreatic cancers and in 2 cases of ampullary malignancies resected via a Whipple procedure. The remaining cases were explored on imaging basis. 30 patients underwent a standard explorative laparotomy, the remainders were explored by laparoscopy. Both groups of patients received multiple biopsies. Results: No difference was found in terms of sensitivity or specificity (p>0.05) Chi2) between laparoscopy and laparotomy regarding the specimens final histology and thus to reach a diagnosis. Morbidity was significantly lower (p< 0:05 Chi2) in the laparoscopic group. No peroperative deaths occurred. Conclusions: Laparoscopy may avoid an unnecessary laparotomy whenever a diagnostic confirmation is required. Laparoscopy may play a key role both to determine the neoplasm operability or the need for adjuvant therapies. Especially immuno- compromised cancer patients may receive an advantage in avoiding, if requested, a staging laparotomy.