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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2000 December;159(6):217-22

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Laparoscopic staging in oncology. A review of the literature

Maculotti L.

Azienda Ospedaliera, Niguarda Ca’ Granda - Milano, Divisione di Chirurgia Generale Andrea Ponti


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Technological progress and gradual miniaturization of equipment had enabled laparoscopy to stage liver, pancreatic, biliary, gastrointestinal and gynecological tumours and lymphoma. In liver neoplasms laparoscopy allows a more extensive examination of the abdominal cavity, revealing superficial lesions measuring less than 1 mm and also offers the opportunity of perioperative ultrasonography and biopsy in patients with coagulation disorders. In pancreatic tumours it allows access to the organ using a supragastric, infragastric and transmesocolic route with a diagnostic sensitivity of 95%, 100% specificity and 96% accuracy with bioptic complications in 3% of cases. In tumours of the gallbladder and the extrahepatic biliary tract it shows a diagnostic accuracy of 96%, as well as a high sensitivity for metastases while establishing the extent of disease. In patients with esophagogastric cancer, laparoscopic staging can avoid unnecessary thoracolaparotomy. It also evaluates resecability of gastric carcinoma with 96% accuracy and is a reliable method for selecting patients for neoadjuvant treatment. In colorectal tumours laparoscopy can be used to assess both extraluminal disease and metastases, helping to establish a rational programme of treatment. In gynecological tumours it is an excellent method for staging comparable to laparotomy with a lower incidence of hemorrhage, shorter hospital stay and lower costs without increasing morbidity. In lymphoma the use of laparoscopy should be considered when percutaneous biopsy is technically impossible, when chromosomal and genetic tests are required for treatment decisions and when the results of CT-guided FNA are incomplete.

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