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

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.