Page 8 - WJOLS - World Journal of Laparoscopic Surgery

Evaluation of Abdominal Malignancies by Minimal Access Surgery
The usefulness and efficacy of laparoscopy as a preoperative tool Thorough evaluation of peritoneal surfaces, omentum,
in the management of intra-abdominal malignancy for diagnosis, presence of ascitic fluid, supra/intrahepatic spaces, surface of the
evaluation, staging, and therapeutic assessment are the areas which bowel, lesser sac, root of the transverse mesocolon, small bowel,
need appraisal and analysis to standardize the procedure and bring ligament of Treitz, abdominal lymph nodes, paracolic gutters
into a more frequent use. and pelvis, prior to any manipulation, ascites when present, fluid
This study explores the applications of laparoscopy with was sent for cytological examination, biopsies were done for any
imaging studies in staging and diagnosis of abdominal malignancy suspicious abdominal lesions, findings of laparoscopy and imaging
and its advantages over only imaging studies and conventional modalities were correlated and further management of the patient
laparotomy, and it seeks to suggest implementation of a defined was decided.
protocol in mandating diagnostic laparoscopy as a necessary
diagnostic tool before an explorative laparotomy.
observAtIons And results
This prospective study was carried out from July 2013 till October
AIm And objectIves 2016. A total of 250 patients with abdominal malignancies were
To assess the role of diagnostic staging laparoscopy in abdominal enrolled in the study. The observations have been shown in the
malignancies. To evaluate the role of laparoscopy as a diagnostic form of charts and tables for ease of understanding as follows.
tool in abdominal malignancies. To compare the findings of Most of the cases were of colorectal malignancies followed by
laparoscopy with noninvasive imaging modalities and assess the gastric malignancy. The mean age of presentation was 52 years,
efficacy of laparoscopy as a definitive tool in the evaluation of with a range between 16 years and 80 years. In our study, out of 250
staging and operability before definitive intervention. patients, 175 (70%) were males and 75 (30%) were females. Among
250 patients, all patients presented with loss of appetite and weight,
mAterIAls And methods 204 (81.6%) presented with pain in abdomen, 124 (49.6%) with lump
This study was a prospective observational study. The study was in abdomen, 110 (44%) with vomiting, 52 (20.8%) with jaundice, 91
conducted in the Department of Surgery, AVBRH, Sawangi (Meghe), (36.4%) with Malena, 79 (31.6%) with hematochezia, and 98 (39.2%)
Wardha. The sample size taken was 250. It was calculated according with altered bowel habits (Fig. 1).
to the formula stated below: The distribution of abdominal malignancies based on the type
of cancer was as follows. Out of 250 patients, 105 (42%) patients were
of colorectal malignancy, 67 (26.8%) patients were of carcinoma
stomach, 23 (9.2%) patients were of biliary tract tumors, 9 (3.6%)
patients were of hepatocellular carcinoma (HCC), 7 (2.8%) patients
n = sample size, Z = standard normal distribution = 1.96, were of periampullary carcinoma, 19 (7.6%) patients were of
P = expected beneficial population = 20%, d = absolute carcinoma head of pancreas, and 9 (3.6%) patients were of ovarian

precision = 5% points (15%–25%), and N = (1.96 × 1.96) × 0.2 × (0.8)/ malignancy. Six (2.4%) patients had presentation of metastatic
(0.05 × 0.05) = 245.86 = 246 disease with unknown primary. In these six cases, with the help
The ethical committee clearance was taken. The duration of of radiology, through endoscopic evaluation and tumor markers,
the study was 3.5 years (July 2013–October 2016). tissue diagnosis could not be obtained, and the source of primary
could not be detected. Out of five (2%) patients in other groups,
Inclusion Criteria one had duodenal malignancy, one had jejunal malignancy, one
Patients of abdominal malignancies who were fit for anesthesia had ileal malignancy, and two cases were of undescended testis
and had given consent for the procedure. (abdominal) harboring malignancy. Out of 105 cases of colorectal
malignancies, 54 (22%) cases were of carcinoma colon, including
Exclusion Criteria carcinoma appendix and caecum and 51 (20.4%) cases were of
Patients with prior multiple surgeries, gross ascites, ASA grade >III, rectal malignancy. Out of 23 cases of biliary tract tumors, 15 (6%)
performance scale: Karnofsky grade <50. cases were of gall bladder carcinoma, and 8 (3.2%) cases were of
cholangiocarcinoma (Fig. 2).
Tools and Methods The distribution of abdominal malignancies based on the
Diagnostic laparoscopy, various imaging modalities (USG/CT/MRI), radiological stage of the cancer was as follows. Out of 250 patients,
histopathological/cytological examination, intraoperative findings. 30 (12%) patients were in stage I, 122 (48.8%) patients were in stage
The tools and procedures were standardized and were performed II, 92 (36.8.8%) patients were in stage III, and 6 (2.4%) patients were
by a single operator from the concerned department. in stage IV (Fig. 3).
The distribution of abdominal malignancies according to the
Technique stage of the cancer based on laparoscopy was as follows. Out of
As per the Society of American Gastrointestinal and Endoscopic 250 patients, 12 (4.8%) patients were in stage I, 69 (27.6%) patients
Surgeons (SAGES) Guidelines. After complete history-taking and were in stage II, 77 (30.8%) patients were in stage III, and the remaining
thorough clinical examination, patients with suspected abdominal most of the patients were in stage IV, i.e., 92 (36.8%) (Table 1).
malignancies were subjected to the following investigations. After comparing radiological and laparoscopic staging, after
diagnostic laparoscopy, a considerable number of cases getting
Investigations diagnosed at stage IV as the p value is quite significant. The
Hematological investigations, tumor marker, chest X-ray, abdomen sensitivity of diagnostic laparoscopy in the overall abdominal
USG, abdomen CT/MRI/MRCP, upper and lower GI endoscopy, malignancy is 93.88%, specificity 54.44%, and diagnostic accuracy
biopsy, and histopathological examination. 68.91%. After comparing radiological and laparoscopic staging,

116 World Journal of Laparoscopic Surgery, Volume 11 Issue 3 (September–December 2018)