Usefulness Of Diagnostic Laparoscopy Over Cect Abdomen In Assessing Operability In Gastrointestinal Malignancy

BACKGROUNDNew advancement in CT scan has greatly helped the surgeons in accurately staging gastrointestinal malignancies and planning its treatment protocols. In this era of minimal invasive surgery, direct vision of the intraabdominal malignancies taking FNAC or biopsy of tumour and assessing its operability can avoid some of the shortcomings of CECT abdomen. It may further help in modifying the treatment protocol for a particular patient if the CECT finding does not match with that of biopsy report or direct laparoscopic assessment of tumour. Here the aim of the study was to find out the overall accuracy of diagnostic laparoscopy abdomen in assessing the operability in cases of gastrointestinal malignancies.METHODSThis was a prospective study of total 40 patients with gastrointestinal malignancy, where all the patients were evaluated by CECT abdomen and found fit to undergo definite surgical procedure. All the patients were subjected to diagnostic and staging laparoscopy to assess the operability at Kalinga Institute of Medical Sciences between August 2012 and November 2014.RESULTSOn preoperative diagnostic staging laparoscopy, it was found that out of 40 cases who were having CECT criteria of operability, 8 had metastatic disease, 8 had unresectable tumour due to local tumour ingrowth and one had benign disease on lap. Assisted tumour biopsy. Also palliative procedures like feeding jejunostomy in two patients with advanced cancer stomach.CONCLUSIONRoutine preoperative diagnostic and staging laparoscopy helped us in detecting advanced disease in significant no. of patient which otherwise was missed in CECT evaluation. Therefore, in our opinion it should be practiced routinely for staging GI malignancy either just before the planned surgery or as a separate diagnostic procedure. It should be added to the investigation modality to detect operability in GI malignancy.