Diagnostic staging laparoscopy: General principles for staging primary digestive malignancies
- Jeffrey Marks, MD
Jeffrey Marks, MD
- Section Editor — Minimally Invasive Surgery
- Professor of Surgery
- University Hospitals
- Case Medical Center
Diagnostic staging laparoscopy (DSL) is performed to determine the feasibility of the proposed curative cancer operation. DSL complements the preoperative assessment of radiographic imaging, which has limitations for identifying regional extension of the primary tumor and/or metastatic disease, such as peritoneal involvement [1,2].
The general principles and approach for performing a DSL for patients with a primary digestive malignancy are reviewed here. Laparoscopic assessment and/or resection of other malignant and benign diseases are discussed in separate topics.
The goal of diagnostic staging laparoscopy (DSL) for primary digestive malignancies is to identify and/or disprove the presence of local, regional, and/or metastatic disease. DSL aids in identifying extra-organ disease that would preclude an attempt for an intended curative resection.
Indications for DSL include :
●Assessment for resectability with curative intent of the following primary digestive cancers:
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- SURGICAL APPROACH
- Incision placement
- Staging procedure
- - One versus two stage approach
- - Collection of fluid for cytology
- - Exploratory principles
- - Biopsies
- Risks and complications
- - Morbidity and mortality
- - Port site tumor implantation
- - False negative explorations
- - Vascular and organ injury
- LAPAROSCOPIC ULTRASOUND
- DIAGNOSTIC ACCURACY AND YIELD FOR SPECIFIC DISEASE SITES
- Esophageal cancer
- Gastric cancer
- Pancreatic and periampullary cancer
- Biliary tract cancer
- Colon or rectal cancer
- SUMMARY AND RECOMMENDATIONS