Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography

Objective To assess the value of diagnostic laparoscopy (DL) and laparoscopic ultrasonography (LUS) in the staging and selection of patients with colorectal liver metastasis. Summary Background Data Preoperative imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging are limited in the assessment of the number and exact location of hepatic metastases and in the detection of extrahepatic metastatic disease. Consequently, the surgeon is often faced with a discrepancy between preoperative imaging results and perioperative findings, resulting in either a different resection than planned or no resection at all. Methods Fifty consecutive patients were planned for DL and LUS in a separate surgical sitting to assess the resectability of their liver metastases. Ail patients were considered to be candidates for resection on the basis of preoperative imaging studies. Results Laparoscopy could not be performed in 3 of the 50 patients because of dense adhesions. The remaining 47 patients underwent DL. On the basis of DL and LUS, 18 (38%) patients were ruled out as candidates for resection. Of the 29 patients who subsequently underwent open exploration and intraoperative ultrasonography, another 6 (13%) were deemed to have unresectable disease. Conclusions The combination of DL and LUS significantly improves the selection of candidates for resection of colorectal liver metastases and effectively reduces the number of unnecessary laparotomies.