Page 21 - Journal of Laparoscopic Surgery

WJOLS

Diagnostic Laparoscopy as an Effective Tool in Evaluation of Intra-abdominal Malignancies
A sampling of retroperitoneal lymph nodes, hepatic removal of the uterus and adnexa, and retroperitoneal
biopsy and direct visualization of the abdominal cavity lymph node sampling are done under surgical staging.
in association with bone marrow aspiration or biopsy Laparoscopic-assisted surgical staging has been proposed
may accomplish laparoscopic staging. as an alternative to laparotomy by combining operative
Routine laparoscopic staging for Hodgkin’s disease laparoscopy and vaginal hysterectomy, for patients early
has shown unsuspected hepatic involvement in 6% of stage endometrial carcinoma.
patients and occult splenic involvement in 13% and has Assessment of the intraperitoneal cavity, sampling
allowed stage upgrading in 23% of patients undergoing through peritoneal washings and definite removal of the
laparoscopic evaluation. Involvement of the liver was adnexa are possible in surgical laparoscopy. 49
present in 20% of patients of Non-Hodgkin’s lymphoma, Clinical outcomes and hospital charges were com-
51
which further proves the greater systemic involvement pared by Gemignani et al. for 320 patients with endo-
of this type of lymphoma. metrial cancer staged by laparoscopy versus traditional
30
Conlon et al. reported a series of 55 laparoscopic laparotomy. An incidence of fewer complications, shorter
procedures performed in patients with diagnosed or inpatient stay, and overall reduced hospital charges was
suspected lymphomas, in which the use of laparoscopy in observed in patients who underwent laparoscopy in
the diagnosis of abdominal lymphomas was established. comparison to those who underwent laparotomy. There
Patients undergoing radiotherapy and chemotherapy for was no statistically significant difference noted in the
lymphoma may be reassessed using laparoscopy for a recurrence rates between the two groups.
second evaluation when imaging studies suggest recur-
rence in the abdominal cavity, as an addition to initial Port-site recurrence
staging and diagnosis. There was an initial concern of higher rates of port site
Minimally invasive procedures for lymphoma may recurrence after staging laparoscopy despite the asso-
offer a mean to minimize the interval between diagnosis, ciation of the procedure with a low (1–2%) rate of major
restaging, and beginning of chemo-radiotherapy when morbidity.
indicated, although this was not evaluated in prospec- Dobronte et al. first reported a case of port-site tumor
tive studies. Reduced pain, reduced inpatient hospital recurrence 2 weeks after laparoscopy in a patient with
stay, sooner resumption of normal activities and ability malignant ascites. Albeit there has been no docu-
52
to initiate chemotherapy earlier than after laparotomy mentation of increased port site recurrence following
make laparoscopy a better choice in the diagnosis and staging laparoscopy as compared with laparotomy, with
staging of a patient with lymphoma. 47
improved expertise and use of an impervious barrier bag
for organ retrieval.
GYNECOLOGIC MALIGNANT DISEASE
Hence, it may be concluded that laparoscopic staging
Application of staging laparoscopy in gynecological appears safe from an oncologic point of view, since port
malignancies has a promising future and is expected to site implantation is uncommon, differs from traditional
metamorphose numerous aspects of its management. open surgical incision recurrence and reflects biological
behavior of the diseases instead of the type of surgery.
Ovarian Cancer
CONCLUSION
Historically, laparoscopy was used for patients with
ovarian cancer in one of two settings: 48,49 In spite of currently available standard radiological tests
• Before the initiating chemotherapy in patients whose such as USG, CT and MRI which are useful in staging the
initial laparotomy was believed to be inadequate abdominal malignancies, a significant percentage of cases
• For reevaluation procedures to determine whether prove to be inoperable because of metastatic or locally
patients had persistent disease after completing their advanced disease. Hence diagnostic/staging laparoscopy
primary chemotherapy. is very useful in preventing non-therapeutic laparotomies
50
Ozols et al. reported a 55% false-negative rate for in these patients and also helps in appropriate palliation
laparoscopy compared with laparotomy and underscored of symptoms.
the need for laparotomy in patients who appear disease-
free at laparoscopy. CLINICAL SIGNIFICANCE
Diagnostic laparoscopy helps in accurate staging of the
Endometrial Cancer
tumor, avoidance of non-therapeutic laparotomies in
In 1998, the staging of endometrial cancer changed patients with metastatic disease and thus, decreasing the
from a clinical to a surgical system. Peritoneal washing, morbidity in such patients. It also helps in the selection
World Journal of Laparoscopic Surgery, May-August 2018;11(2):68-75 73