Clinical and economic consequences of work-up without laparoscopy in patients with CRC liver metastases

Background: Multi-detector computed tomography (MDCT) has dramatically improved in recent years. In a previous study we suggested that diagnostic laparoscopy (DL) and laparoscopic ultrasonography (LUS) no longer should be mandatory in the work-up of patients with colorectal (CRC) liver metastases. The aim of the present study was to evaluate the clinical and economic consequences of such a strategy. Material/Methods: Seventy consecutive patients considered to have resectable liver metastases after MDCT were analysed. A pre-operative treatment strategy was in each case planned according to the result of the MDCT-scan. Patients considered to have incurable disease during operation were recorded, as were cases where the operative strategy had to be altered. For evaluating the economic and clinical consequences of adding a preoperative LUS, procedural and marginal cost effectiveness was calculated. Results: Seventy patients underwent laparotomy. Three patients (4%) were considered incurable peroperatively and in 15 cases (21%) the strategy had to be altered. The average cost for a successful LUS was EUR 2 394 and the marginal costs for supplementing every MDCT with a LUS were EUR 59 849. Conclusions: MDCT is sufficient and cost effective as the only preoperative work-up in patients with colorectal liver metastases.