Staging laparoscopy in the management of intra-abdominal XXXX .

@entity1 @entity5 @entity189 @entity344 @entity2248 @entity3
BACKGROUND: Laparoscopy in the evaluation of intra-abdominal @entity5 has become a debated issue. Proponents have claimed that it increases resectability rates, whereas opponents suggest that many @entity1 require laparotomy regardless of the laparoscopic findings. The purpose of this study was to compare outcomes in @entity1 undergoing staging laparoscopy versus those who were managed by initial exploratory laparotomy. METHODS: The medical records of all @entity1 during an 18-month period who underwent surgical evaluation for upper @entity344 were reviewed. Forty-eight @entity1 underwent staging laparoscopy (SL) initially; 80 @entity1 underwent initial exploratory laparotomy (EL). Data obtained included type of @entity5 , laparoscopic findings, laparoscopic determination of resectability, laparoscopic procedures, open determination of resectability, open procedures, and length of stay (LOS). Statistical analysis was done by using Fisher exact test or the Mann-Whitney U test. RESULTS: The @entity5 of 75% of @entity1 were deemed resectable by SL. Of these, 77.8% were resected. This compares to 56.3% resectability rate in the EL group (P = .025). SL findings in @entity1 with unresectable @entity5 were @entity189 (75%), liver @entity3 (33.3%), and direct invasion (16.7%). In the 8 false-negative @entity2248 , 75% were unresectable as a result of vascular invasion and 25% for other reasons. Findings in the EL group whose @entity5 were unresectable were @entity189 (34.3%), direct invasion (22.6%), liver @entity3 (42.9%), and vascular invasion only (17.1%). Therefore 82.9% of @entity1 in the EL group could have been determined to have unresectable @entity5 by SL. In the EL group 22.5% of the laparotomies were nontherapeutic, whereas 4.2% of @entity1 in the SL group underwent nontherapeutic laparotomy. Average LOS for unresectable @entity1 in the SL group was 0.5 days, with 75% discharged the same day of operation. This compares to 10.9 days in the EL group (P < .00001) and 7.6 days in the nontherapeutic EL group (P < .00001). CONCLUSIONS: SL increases the resectability rate, decreases the nontherapeutic laparotomy rate, and decreases LOS in @entity1 with unresectable disease. SL is poor at detecting unresectability as a result of vascular invasion only, but this accounts for less than one-fifth of @entity1 . Laparoscopic sonography and palliation may further decrease the need for EL.
