Laparoscopy for diagnosis and staging of hepatobiliary malignancies

Objective: To review the role of diagnostic laparoscopy (DL) for staging of malignant diseases of the liver and biliary tract. Methodology: Critical review of the current literature. Results: Analysis of the utility of DL in hepatobiliary cancers depends on several criteria, particularly in the era of high quality prelaparotomy and pre-DL imaging. Selection criteria for DL, selection criteria for resection, definition of resectability, patterns of intra- and extrahepatic spread, association with underlying liver disease and frequency of indications for palliative laparotomy impact the utility of DL depending on the disease studied. Conclusions: DL has a very limited role for staging patients with colorectal liver metastases as a result of expanding definitions of resectability, multistage approaches to bilateral metastases, and methods to increase resectability such as portal vein embolization and preoperative chemotherapy. For hepatocellular carcinoma, DL can be useful for staging patients with advanced tumours and cirrhosis, and might have an emerging role for the evaluation of transplant candidates with equivocal imaging findings. For biliary cancers, DL is indicated for patients with advanced stage hilar cholangiocarcinoma and gall bladder carcinoma.