Value of laparoscopy and laparoscopic ultrasonography in determining resectability of colorectal hepatic metastases

Background The aim was to assess the value of laparoscopy and laparoscopic ultrasonography (LUS) in selecting patients for resection of colorectal hepatic metastases. Methods Sixty patients with potentially resectable colorectal hepatic metastases after helical computer tomography (CT) and scheduled to undergo laparoscopy and LUS were studied retrospectively. Primary outcome measurement was the number of cases in which laparoscopy and LUS resulted in a change of therapeutic approach. Results Of the 60 patients, 59 patients were examined by LUS and/or laparoscopy. The small intestine was perforated due to adhesions in two patients, necessitating open exploration in one of them. In 17 patients (29%) the combined laparoscopic procedure yielded results prohibiting resection; another 6 patients were denied resection on other grounds. Of the 36 patients who underwent open exploration, 31 underwent resection. Combined laparoscopy and LUS predicted resectability correctly in 86% of the patient group. Compared with resection, the sensitivity of both CT and LUS to detect lesions was 91%. Discussion Laparoscopy and LUS can avoid open exploration without resection in a substantial number of patients considered eligible for resection of colorectal hepatic metastases based on CT. LUS does not seem to detect more metastases than CT.