Clinical Risk Score predicts yield of staging laparoscopy in patients with colorectal liver metastases

Background: Resection offers the only realistic chance of cure for hepatic colorectal metastases. The aim of this study was to examine the potential of laparoscopy and laparoscopic intraoperative ultrasonography (IOUS) for detecting incurable disease, and to determine whether the Clinical Risk Score (CRS) is useful in selecting patients for laparoscopy before hepatic resection.

Methods: All patients with potentially curable colorectal liver metastases who underwent staging laparoscopy and laparoscopic IOUS before planned hepatic resection between January 2000 and December 2004 were included. A preoperative CRS was determined for each patient and correlated with curability.

Results: Two hundred patients were identified, of whom 133 were found to have resectable disease at laparotomy. Laparoscopy detected 39 (58 per cent) of 67 patients with incurable disease, changing the management in 19.5 per cent of the 200 patients. The CRS correlated with the likelihood of detecting incurable disease; incurable disease was present in two of 31 patients with a CRS of 0-1, 35 of 129 with a score of 2-3 and 30 of 40 with a score of 4-5. The potential benefit of laparoscopy increased progressively with increasing CRS, changing management in none of 31 patients with a CRS of 0-1, 18 of 129 with a score of 2-3 and 21 of 40 with a score of 4-5.

Conclusion: Staging laparoscopy and IOUS detected more than half of the incurable disease in this cohort. Laparoscopy had a low diagnostic yield in patients with a CRS of 0-1 and its routine use in this group of patients is therefore not recommended.