Home Current issue Ahead of print Search About us Editorial board Archives Submit article Instructions Subscribe Contacts Login 
Year : 2017  |  Volume : 36  |  Issue : 3  |  Page : 291-296

Value of staging laparoscopy for the assessment of operability in periampullary cancer patients: a comparative study versus exploratory laparotomy

Department of Surgery, Faculty of Medicine, Cairo University, Egypt

Correspondence Address:
Hany A Balamoun
FRCS Lecturer of General Surgery, Department of General Surgery, Faculty of Medicine, Cairo University, 11562
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejs.ejs_33_17

Rights and Permissions

Objectives The aim of this study was to evaluate the diagnostic yield of staging laparoscopy (SL) for patients with periampullary cancer with no signs of inoperability on computed tomography (CT) imaging. Patients and methods Thirty-eight patients with malignant obstructive jaundice were considered for this study. Only patients with no distant metastases and with lesions potentially resectable on CT criteria were included. Patients were randomized to two groups: group A included patients who underwent exploratory laparotomy (EL) based on CT findings, and group B included patients who were subjected to SL and then proceeded to laparotomy according to SL findings. Primary outcomes included the frequency of cancelled laparotomy and the frequency of positive laparoscopy, indicating inoperability or irresectability. Results EL confirmed CT findings in eight (42.1%) patients of the EL group. In total, resection was not indicated nor possible in 11 patients of the, Replace:=wdReplaceAll, Format:=True, Forward:=True, MatchWildcards:=False, Wrap:=wdFindStop EL group and were considered as false positive for CT. SL confirmed CT findings in seven (36.8%) patients of the SL group. SL detected signs of inoperability in 12 patients. In total, resection was not indicated nor possible in 13 patients of the SL group and were considered as false positive for CT. Collectively, CT could define operability and lesion resectability with a positive predictive value (PPV) of 36.8% and low specificity. However, preliminary SL could define operability and lesion resectability of patients with free CT with a PPV of 85.7% (95% confidence interval: 47.72–97.53) and specificity rate of 92.3% (95% confidence interval: 63.97–99.81). Conclusion Reliance on CT imaging alone for defining operability of patients with periampullary is accompanied by a relatively high unnecessary laparotomy rate. SL should be considered for defining inoperability with high PPV and specificity. SL could spare unnecessary laparotomy in around 50% and allowed shorter theater time and postoperative hospital stay for inoperable patients compared with EL.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded39    
    Comments [Add]    

Recommend this journal