Clinical Rescue Evaluation in Laparoscopic Surgery for Hepatic Metastases by Colorectal Cancer

Aim: Laparoscopy is an increasingly important tool in the staging and treatment for potentially resectable liver metastases. The clinical risk score (CRS) is useful in selecting patients for diagnostic laparoscopy before planning resection of colorectal metastases. This study evaluates the effect of staging laparoscopy (SL) combined with CRS. Materials and Methods: From January 2004 to December 2007, CRS evaluation and SL were performed in 65 consecutive patients with colorectal metastases, before planned open-exploration and resection. Patients were assigned to a CRS, which is based on 5 factors related to the primary tumor and the hepatic disease. This study was aimed at recognizing occult unresectable metastases, by combining laparoscopy and CRS. Results: Only 62 patients had a complete SL examination (3 were excluded for dense adhesions). A group of 24 patients was identified as unresectable, and 38 patients as resectable. In the latter group, 3 patients directly had laparoscopic treatment. In all, 38 patients underwent laparotomy (35 resectable, and 3 patients with dense adhesions that could not have a complete laparoscopic treatment). Resection was carried out in 30 of 38 (78.9%) cases, and the remaining 21% gave false-negative results. In all, there were 32 of 65 (49.2%) unresectable patients, and 75% of them were recognized by SL. Conclusions: Laparoscopy identified the majority of patients with occult unresectable disease, improved resectability, and it should be a routine in patients being considered for potentially curative hepatic resection. The CRS, earlier shown to predict survival after hepatic resection, identifies high-risk patients, who are most likely to benefit from laparoscopy, and may improve resource utilization.