دورية أكاديمية
أعرض في EDS

Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction.

التفاصيل البيبلوغرافية
العنوان: Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction.
المؤلفون: Tilleman EH; Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands., de Castro SM, Busch OR, Bemelman WA, van Gulik TM, Obertop H, Gouma DJ
المصدر: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2002 May-Jun; Vol. 6 (3), pp. 426-30; discussion 430-1.
نوع المنشور: Evaluation Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier B.V Country of Publication: United States NLM ID: 9706084 Publication Model: Print Cited Medium: Print ISSN: 1091-255X (Print) Linking ISSN: 1091255X NLM ISO Abbreviation: J Gastrointest Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: 2024-: [Amsterdam] : Elsevier B.V.
Original Publication: St. Louis, MO : Quality Medical Pub., c1997-
مواضيع طبية MeSH: Laparoscopy*, Bile Duct Neoplasms/*diagnosis , Cholestasis/*etiology, Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/diagnostic imaging ; Bile Duct Neoplasms/pathology ; Bile Duct Neoplasms/surgery ; Female ; Humans ; Liver Neoplasms/pathology ; Male ; Middle Aged ; Neoplasm Staging/methods ; Peritoneal Neoplasms/pathology ; Ultrasonography
مستخلص: Tumor staging in patients with a malignant obstruction of the proximal bile duct is focused on selecting patients who could benefit from a resection. Diagnostic laparoscopy, which has proved its value in several gastrointestinal malignancies, has been used routinely at our hospital since 1993 in patients with a malignant obstruction of the proximal bile duct, although data in the literature with regard to its additional value are conflicting. Therefore the diagnostic accuracy of diagnostic laparoscopy in patients with malignant proximal bile duct obstruction was evaluated. From January 1993 to May 2000, diagnostic laparoscopy was performed in 110 patients (61 males and 49 females), with a mean age of 60 years (range 30 to 80 years), who had a suspected malignant proximal bile duct tumor and in whom "potential resectability" was demonstrated by means of conventional radiologic staging methods (i.e., ultrasound combined with Doppler imaging, CT, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography). Laparoscopy revealed histologically proved incurable disease in 44 (41%) of the 110 patients (31 with metastases and 13 with extensive tumor ingrowth). Laparoscopic ultrasound imaging, however, revealed histologically proved incurable disease in one patient (1%), thereby preventing exploratory laparotomy in 46 because these patients had already been treated by palliative endoscopic stent placement. The remaining 65 patients were staged as having a resectable tumor and underwent surgical exploration. Thirty patients had an unresectable tumor (distant metastases in five; tumor ingrowth in surrounding tissues in 24) or benign disease (one patient). Sensitivity and negative predictive value of diagnostic laparoscopy for detecting unresectable disease were 60% and 52%, respectively. Diagnostic laparoscopy avoided unnecessary laparotomy in 41% of patients with a malignant proximal bile duct obstruction considered resectable according to conventional imaging studies. The additional value of laparoscopic ultrasound was limited. Therefore diagnostic laparoscopy should be performed routinely in the workup of patients with a potentially resectable proximal bile duct tumor.
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تواريخ الأحداث: Date Created: 20020523 Date Completed: 20020812 Latest Revision: 20240213
رمز التحديث: 20240213
DOI: 10.1016/s1091-255x(02)00005-7
PMID: 12022996
قاعدة البيانات: MEDLINE
الوصف
تدمد:1091-255X
DOI:10.1016/s1091-255x(02)00005-7