Sreenivasan, K (2006) Role of Pretreatment Laparoscopy in Selective Abdominal Malignancy. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Although surgeons and gastroenterologists have used diagnostic laparoscopy since the early 1900s, today's surgical oncologists have been relatively slow to embrace this technology. Together with the fervor and benefits afforded by laparoscopic therapeutic interventions in the management of patients with benign disease and the diagnostic usefulness in blunt trauma and abdominal pain, awareness has been rekindled regarding the advantages of laparoscopy for the staging of abdominal malignancy. The morbidity and mortality of exploratory laparotomy with unresectable tumors has been from 13 to 23% and 10 to 21% respectively42. As surgeons begin to realize that extirpative procedures are doomed to failure in curing patients with diffuse abdominal metastases disclosed on laparoscopic assessment, palliative measures, such as stent placement, ablative procedures, balloon dilatation, intraluminal high-dose radiation, and laser techniques will be used commonly by surgical endoscopists and gastroenterologists. Similarly, it is hoped that the use of systemic chemotherapy will achieve better specificity in cell destruction in patients identified laparoscopically to have uncontained disease in the abdominal cavity. The sensitivity of imaging combined with laparoscopy has been shown to approach that of celiotomy in the evaluation of solid organs, thereby avoiding unnecessary laparotomy and its associated morbidities. Using imaging as a complement to laparoscopy will extend the usefulness of both techniques. The application of laparoscopy and the advent of miniaturized laparoscopic instrumentation, both diagnostic and therapeutic, in the management of patients with abdominal malignancy will be limited only by the creativity and expertise of physicians and instrument makers. AIM : The aim of the present study were to evaluate the relative benefit of the ‘pretreatment / diagnostic laparoscopy’ in selective patients of intra-abdominal malignancy for identifying occult surface metastasis and locally invasive lesions, thereby reducing unnecessary / nontherapeutic laparotomy and their associated morbidity and mortality. The present imaging (USG, CT-scan, MRI) fails to identify all the metastasis and local invasion lesions especially when metastasis are below 1 cm. in size. MATERIALS & METHODS : The present study was done in the Department of Surgical Gastroenterology, Madras Medical College, Chennai-3, from September 2003 to October 2005 in a series of 60 patients of which 40 males, 20 females and age varied from 35 to 77 years. The pretreatment laparoscopy were performed in selective patients with intra-abdominal malignancy in order to accurately stage their lesions and ascertain resectability. Patients in whom conventional imaging had disclosed obviously unresectable lesions (i.e. ascites, pelvic deposits, distant lymphadenopathy, liver metastases) were excluded from present study. Patients with comorbid diseases, complications requiring open palliative bypass procedures were also excluded from this study. CONCLUSION : Pretreatment / diagnostic laparoscopy is safe, effective and carries minimal complications. It can be done in selective group of abdominal malignancy to prognosticate the diseases outcome and to avoid unnecessary / non-therapeutic laparotomy, morbidity and mortality associated with it and it also increases the rate of resectability. The laparoscopy is an important tool in the staging of intra-abdominal malignancy for patients with locally advanced disease without signs of tumor spread in imaging. It is a relatively simple, welltolerated and safe procedure. It should be considered in all patients with ‘imaging-based’ resectable intra-abdominal malignancy in which laparotomy is planned, either to establish the diagnosis or before an attempt at resective surgery. Accurate tumor staging facilitates the selection of patients for resection, neoadjuvant therapy and selective planning for better palliation. It differentiates potentially resectable localized disease from those with advanced or metastatic disease. Laparoscopy has a role in establishing the diagnosis in some situation by allowing guided biopsy of the intra / retroperitoneal masses, lymph node, peritoneal and visceral surface lesions. Laparoscopy also has a role in the surgical treatment and in palliative care such as feeding tube placement, stoma creation. Since it may benefit or adversely affect the survival or quality of life, ‘Pretreatment laparoscopy’ can be used in carefully selected patients.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Pretreatment Laparoscopy ; Abdominal Malignancy. |
| Subjects: | MEDICAL > Surgical Gastroenterology and Proctology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 27 Jul 2017 03:38 |
| Last Modified: | 27 Jul 2017 03:38 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2209 |
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