The Evolving Role of Staging Laparoscopy in the Treatment of Colorectal Hepatic Metastasis
HYPOTHESIS Laparoscopy is an increasingly important tool in the staging and treatment of hepatic malignancies. This study evaluates the effect of staging laparoscopy (SL) using intraoperative ultrasonography (IOUS) on the regional treatment of isolated hepatic colorectal metastasis. DESIGN Analytic...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2005-08, Vol.140 (8), p.727-734 |
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| creator | Thaler, Klaus Kanneganti, Shalini Khajanchee, Yashohdan Wilson, Charlyn Swanstrom, Lee Hansen, Paul D |
| description | HYPOTHESIS Laparoscopy is an increasingly important tool in the staging and treatment of hepatic malignancies. This study evaluates the effect of staging laparoscopy (SL) using intraoperative ultrasonography (IOUS) on the regional treatment of isolated hepatic colorectal metastasis. DESIGN Analytic cohort study. SETTING Tertiary care center. PATIENTS Consecutive patients who have a colorectal metastasis confined to the liver and selected for surgical regional treatment. INTERVENTIONS All patients underwent preoperative evaluation followed by SL/IOUS. Operative plans were based on preoperative imaging and were either carried out or altered intraoperatively according to SL/IOUS findings. MAIN OUTCOME MEASURE Effect of SL/IOUS on surgical management. RESULTS Between September 1996 and May 2004 one hundred fifty-two SL/IOUSs were performed in 136 patients (77 males and 59 females), who had a mean (SD) age of 63 (11) years. Data sets were complete in 138 events. All patients had isolated hepatic disease as defined by preoperative computed tomography in 152 (100%) and positron emission tomography in 107 (70%). Staging laparoscopy/IOUS identified surgically untreatable disease in 34 events (25%) because of peritoneal metastases (n = 15), nodal involvement (n = 11), diffuse hepatic disease (n = 5), no identifiable disease (n = 2), and untreatable disease (n = 1). Laparoscopic treatment events included radiofrequency ablations (n = 78), hepatic artery pump implantations (n = 40), resections (n = 26), and combined procedures (n = 37). Overall, SL/IOUS changed the treatment plan in 66 (48%) of 138 of events. This includes 32 (23%) of 138 events in which SL/IOUS findings significantly altered the actual procedure performed relative to the preoperative plan. Three minor complications occurred in the SL/IOUS-only group with a mean (SD) hospital stay of 1.3 (1) days. CONCLUSION In the regional management of isolated colorectal hepatic metastasis, SL/IOUS avoids unnecessary laparotomies and influences definitive surgical intervention in a substantial proportion of patients.Arch Surg. 2005;140:727-734--> |
| doi_str_mv | 10.1001/archsurg.140.8.727 |
| format | Article |
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This study evaluates the effect of staging laparoscopy (SL) using intraoperative ultrasonography (IOUS) on the regional treatment of isolated hepatic colorectal metastasis. DESIGN Analytic cohort study. SETTING Tertiary care center. PATIENTS Consecutive patients who have a colorectal metastasis confined to the liver and selected for surgical regional treatment. INTERVENTIONS All patients underwent preoperative evaluation followed by SL/IOUS. Operative plans were based on preoperative imaging and were either carried out or altered intraoperatively according to SL/IOUS findings. MAIN OUTCOME MEASURE Effect of SL/IOUS on surgical management. RESULTS Between September 1996 and May 2004 one hundred fifty-two SL/IOUSs were performed in 136 patients (77 males and 59 females), who had a mean (SD) age of 63 (11) years. Data sets were complete in 138 events. All patients had isolated hepatic disease as defined by preoperative computed tomography in 152 (100%) and positron emission tomography in 107 (70%). Staging laparoscopy/IOUS identified surgically untreatable disease in 34 events (25%) because of peritoneal metastases (n = 15), nodal involvement (n = 11), diffuse hepatic disease (n = 5), no identifiable disease (n = 2), and untreatable disease (n = 1). Laparoscopic treatment events included radiofrequency ablations (n = 78), hepatic artery pump implantations (n = 40), resections (n = 26), and combined procedures (n = 37). Overall, SL/IOUS changed the treatment plan in 66 (48%) of 138 of events. This includes 32 (23%) of 138 events in which SL/IOUS findings significantly altered the actual procedure performed relative to the preoperative plan. Three minor complications occurred in the SL/IOUS-only group with a mean (SD) hospital stay of 1.3 (1) days. CONCLUSION In the regional management of isolated colorectal hepatic metastasis, SL/IOUS avoids unnecessary laparotomies and influences definitive surgical intervention in a substantial proportion of patients.Arch Surg. 2005;140:727-734--></description><identifier>ISSN: 0004-0010</identifier><identifier>ISSN: 2168-6254</identifier><identifier>EISSN: 1538-3644</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/archsurg.140.8.727</identifier><identifier>PMID: 16103281</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Cohort Studies ; Colorectal cancer ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - therapy ; Female ; Hepatectomy - methods ; Humans ; Laparoscopy - methods ; Liver ; Liver Neoplasms - mortality ; Liver Neoplasms - pathology ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Medical procedures ; Middle Aged ; Morbidity ; Neoplasm Staging - methods ; Positron-Emission Tomography - methods ; Preoperative Care - methods ; Prognosis ; Retrospective Studies ; Risk Assessment ; Surgery ; Survival Analysis ; Tomography ; Tomography, X-Ray Computed - methods ; Treatment Outcome</subject><ispartof>Archives of surgery (Chicago. 1960), 2005-08, Vol.140 (8), p.727-734</ispartof><rights>Copyright American Medical Association Aug 2005</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a390t-7a8193c721d6464e9f95827ffa71df470e2f32d8ab4b650c728a9119193acf773</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/archsurg.140.8.727$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.140.8.727$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76458,76461</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16103281$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thaler, Klaus</creatorcontrib><creatorcontrib>Kanneganti, Shalini</creatorcontrib><creatorcontrib>Khajanchee, Yashohdan</creatorcontrib><creatorcontrib>Wilson, Charlyn</creatorcontrib><creatorcontrib>Swanstrom, Lee</creatorcontrib><creatorcontrib>Hansen, Paul D</creatorcontrib><title>The Evolving Role of Staging Laparoscopy in the Treatment of Colorectal Hepatic Metastasis</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>Arch Surg</addtitle><description>HYPOTHESIS Laparoscopy is an increasingly important tool in the staging and treatment of hepatic malignancies. This study evaluates the effect of staging laparoscopy (SL) using intraoperative ultrasonography (IOUS) on the regional treatment of isolated hepatic colorectal metastasis. DESIGN Analytic cohort study. SETTING Tertiary care center. PATIENTS Consecutive patients who have a colorectal metastasis confined to the liver and selected for surgical regional treatment. INTERVENTIONS All patients underwent preoperative evaluation followed by SL/IOUS. Operative plans were based on preoperative imaging and were either carried out or altered intraoperatively according to SL/IOUS findings. MAIN OUTCOME MEASURE Effect of SL/IOUS on surgical management. RESULTS Between September 1996 and May 2004 one hundred fifty-two SL/IOUSs were performed in 136 patients (77 males and 59 females), who had a mean (SD) age of 63 (11) years. Data sets were complete in 138 events. All patients had isolated hepatic disease as defined by preoperative computed tomography in 152 (100%) and positron emission tomography in 107 (70%). Staging laparoscopy/IOUS identified surgically untreatable disease in 34 events (25%) because of peritoneal metastases (n = 15), nodal involvement (n = 11), diffuse hepatic disease (n = 5), no identifiable disease (n = 2), and untreatable disease (n = 1). Laparoscopic treatment events included radiofrequency ablations (n = 78), hepatic artery pump implantations (n = 40), resections (n = 26), and combined procedures (n = 37). Overall, SL/IOUS changed the treatment plan in 66 (48%) of 138 of events. This includes 32 (23%) of 138 events in which SL/IOUS findings significantly altered the actual procedure performed relative to the preoperative plan. Three minor complications occurred in the SL/IOUS-only group with a mean (SD) hospital stay of 1.3 (1) days. CONCLUSION In the regional management of isolated colorectal hepatic metastasis, SL/IOUS avoids unnecessary laparotomies and influences definitive surgical intervention in a substantial proportion of patients.Arch Surg. 2005;140:727-734--></description><subject>Aged</subject><subject>Cohort Studies</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Female</subject><subject>Hepatectomy - methods</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Liver</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Medical procedures</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Neoplasm Staging - methods</subject><subject>Positron-Emission Tomography - methods</subject><subject>Preoperative Care - methods</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><issn>0004-0010</issn><issn>2168-6254</issn><issn>1538-3644</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkF1LwzAUhoMobn78AL2Q4oV3rflqk17KmB8wEXTeeBPOumSrtE1NUsF_b8amghBIDnnewzkPQucEZwRjcg2uWvvBrTLCcSYzQcUeGpOcyZQVnO-jMcaYp5HEI3Tk_Xt8UVnSQzQiBcGMSjJGb_O1Tqaftvmsu1XybBudWJO8BFht6hn04KyvbP-V1F0SIjt3GkKru7DhJraxTlcBmuRe9xDqKnnUAXw8tT9BBwYar0939zF6vZ3OJ_fp7OnuYXIzS4GVOKQCJClZJShZFrzgujRlLqkwBgRZGi6wpobRpYQFXxQ5jqCEkpAyhqAyQrBjdLXt2zv7MWgfVFv7SjcNdNoOXhWSywLzIoKX_8B3O7guzqYoo3nOKScRoluoiot7p43qXd2C-1IEq4129aNdRe1Kqqg9hi52nYdFq5d_kZ3nCJxtAWjh9zfHUmLOvgG-vodp</recordid><startdate>20050801</startdate><enddate>20050801</enddate><creator>Thaler, Klaus</creator><creator>Kanneganti, Shalini</creator><creator>Khajanchee, Yashohdan</creator><creator>Wilson, Charlyn</creator><creator>Swanstrom, Lee</creator><creator>Hansen, Paul D</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20050801</creationdate><title>The Evolving Role of Staging Laparoscopy in the Treatment of Colorectal Hepatic Metastasis</title><author>Thaler, Klaus ; Kanneganti, Shalini ; Khajanchee, Yashohdan ; Wilson, Charlyn ; Swanstrom, Lee ; Hansen, Paul D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a390t-7a8193c721d6464e9f95827ffa71df470e2f32d8ab4b650c728a9119193acf773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Cohort Studies</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - mortality</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - therapy</topic><topic>Female</topic><topic>Hepatectomy - methods</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Liver</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Medical procedures</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Neoplasm Staging - methods</topic><topic>Positron-Emission Tomography - methods</topic><topic>Preoperative Care - methods</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><toplevel>online_resources</toplevel><creatorcontrib>Thaler, Klaus</creatorcontrib><creatorcontrib>Kanneganti, Shalini</creatorcontrib><creatorcontrib>Khajanchee, Yashohdan</creatorcontrib><creatorcontrib>Wilson, Charlyn</creatorcontrib><creatorcontrib>Swanstrom, Lee</creatorcontrib><creatorcontrib>Hansen, Paul D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of surgery (Chicago. 1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thaler, Klaus</au><au>Kanneganti, Shalini</au><au>Khajanchee, Yashohdan</au><au>Wilson, Charlyn</au><au>Swanstrom, Lee</au><au>Hansen, Paul D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Evolving Role of Staging Laparoscopy in the Treatment of Colorectal Hepatic Metastasis</atitle><jtitle>Archives of surgery (Chicago. 1960)</jtitle><addtitle>Arch Surg</addtitle><date>2005-08-01</date><risdate>2005</risdate><volume>140</volume><issue>8</issue><spage>727</spage><epage>734</epage><pages>727-734</pages><issn>0004-0010</issn><issn>2168-6254</issn><eissn>1538-3644</eissn><eissn>2168-6262</eissn><abstract>HYPOTHESIS Laparoscopy is an increasingly important tool in the staging and treatment of hepatic malignancies. This study evaluates the effect of staging laparoscopy (SL) using intraoperative ultrasonography (IOUS) on the regional treatment of isolated hepatic colorectal metastasis. DESIGN Analytic cohort study. SETTING Tertiary care center. PATIENTS Consecutive patients who have a colorectal metastasis confined to the liver and selected for surgical regional treatment. INTERVENTIONS All patients underwent preoperative evaluation followed by SL/IOUS. Operative plans were based on preoperative imaging and were either carried out or altered intraoperatively according to SL/IOUS findings. MAIN OUTCOME MEASURE Effect of SL/IOUS on surgical management. RESULTS Between September 1996 and May 2004 one hundred fifty-two SL/IOUSs were performed in 136 patients (77 males and 59 females), who had a mean (SD) age of 63 (11) years. Data sets were complete in 138 events. All patients had isolated hepatic disease as defined by preoperative computed tomography in 152 (100%) and positron emission tomography in 107 (70%). Staging laparoscopy/IOUS identified surgically untreatable disease in 34 events (25%) because of peritoneal metastases (n = 15), nodal involvement (n = 11), diffuse hepatic disease (n = 5), no identifiable disease (n = 2), and untreatable disease (n = 1). Laparoscopic treatment events included radiofrequency ablations (n = 78), hepatic artery pump implantations (n = 40), resections (n = 26), and combined procedures (n = 37). Overall, SL/IOUS changed the treatment plan in 66 (48%) of 138 of events. This includes 32 (23%) of 138 events in which SL/IOUS findings significantly altered the actual procedure performed relative to the preoperative plan. Three minor complications occurred in the SL/IOUS-only group with a mean (SD) hospital stay of 1.3 (1) days. CONCLUSION In the regional management of isolated colorectal hepatic metastasis, SL/IOUS avoids unnecessary laparotomies and influences definitive surgical intervention in a substantial proportion of patients.Arch Surg. 2005;140:727-734--></abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>16103281</pmid><doi>10.1001/archsurg.140.8.727</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cohort Studies Colorectal cancer Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Female Hepatectomy - methods Humans Laparoscopy - methods Liver Liver Neoplasms - mortality Liver Neoplasms - pathology Liver Neoplasms - secondary Liver Neoplasms - surgery Male Medical procedures Middle Aged Morbidity Neoplasm Staging - methods Positron-Emission Tomography - methods Preoperative Care - methods Prognosis Retrospective Studies Risk Assessment Surgery Survival Analysis Tomography Tomography, X-Ray Computed - methods Treatment Outcome |
| title | The Evolving Role of Staging Laparoscopy in the Treatment of Colorectal Hepatic Metastasis |
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