Staging Laparoscopy Detected Occult Metastases in 11.5% of Gallbladder Cancer Patients

A study in the World Journal of Surgery evaluated the incremental diagnostic yield of staging laparoscopy in gallbladder cancer, where occult metastases can lead to nontherapeutic laparotomy despite imaging-based staging. Investigators analyzed a prospectively maintained database from a high-volume institution. Among 330 patients, laparoscopy was performed before planned radical cholecystectomy in 210 (63.6%) and before initiation of systemic therapy in 120 (36.4%).

Staging laparoscopy detected metastases not identified by cross-sectional imaging in 38 patients, an incremental yield of 11.5%. Equivocal uptake on fluorodeoxyglucose PET/CT and prior neoadjuvant chemotherapy were significant predictors of metastatic disease detected at laparoscopy (p < 0.001 and p = 0.026, respectively). Separately, reported reasons for inoperability at laparotomy included metastatic 16b1 lymph nodes in 19 patients, locally unresectable disease in 15, and peritoneal and liver metastases in two patients each. Local unresectability was attributed to right hepatic artery encasement at the porta hepatis.

The findings support an additional staging role for laparoscopy but also show that unresectable disease may still be found at laparotomy. The authors advocate incorporating laparoscopy into management of all gallbladder cancer patients. However, this single-center observational analysis included different treatment pathways; the abstract does not report subgroup diagnostic yields, predictor effect sizes, or comparative clinical outcomes. Full text was unavailable for assessment.