Laparoscopy and Laparoscopic Ultrasound

Abstract

Hilar cholangiocarcinoma usually presents late with a poor prognosis that results in diagnostic and therapeutic challenges for the clinician. For individuals diagnosed with cholangiocarcinoma, surgery currently offers the only potential curative option, however a laparotomy and surgical resection of localized disease is itself associated with significant morbidity and mortality [1–3]. For patients diagnosed with advanced disease, life expectancy is short and survival in those who have incomplete tumour resection is identical to patients who receive palliative therapy alone for non resectable illness [1]. The benefits of avoiding laparotomy can therefore not be overemphasized and include less pain and morbidity, decreased hospital stay, decreased overall cost and earlier initiation of palliative therapy [2, 3]. Consequently, adequate staging is of utmost importance to prevent unnecessary laparotomy in those with advanced illness not suitable for potentially curative surgery. Whenever surgical palliation is preferred, laparotomy is indicated, regardless of tumour resectability. Nevertheless, despite improvements in imaging, the incidence of non therapeutic laparotomies remains high, up to 46 % in some studies [1].