Laparoscopic Ultrasound Enhances Standard Laparoscopy in the Staging of Pancreatic Cancer

Minnard, Emery A.; Conlon, Kevin C.; Hoos, Axel; Dougherty, Ellen; Hann, Lucy E.; Brennan, Murray F.

doi:10.1097/00000658-199808000-00006

Cited by 145 publications

(65 citation statements)

References 25 publications

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“…In a cohort of 90 subjects with pancreatic cancer, laparoscopic US concluded the resectability in 13 patients (14%), where laparoscopic analysis alone had led to vagueresults [8].…”

Section: Discussionmentioning

confidence: 99%

“…[8] Moreover, Hunerbein et al [9] stated that laparoscopic US added additional data to laparoscopy in 12% of subjects with pancreatic cancer, who were establish to have resectable disease on preoperative US, CT and MRI. The mixture of SL with US in this work confirmed irresectability in 57% of cases with a consequential change in surgical plan.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Laparoscopy and Laparoscopic Ultrasound in Staging and in Palliation of Upper Gastro-Intestinal Malignancies: The Egyptian National Cancer Institute Experience

Gad¹,

Gareer²,

El-Malt³

et al. 2017

JCT

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Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precise staging is the pouring force behind the use of diagnostic laparoscopy (DL). Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Study design: In this prospective study, 62 patients with lower esophageal, gastric and peri-pancreatic carcinomas were joined after written informed consent. All patients were examined with laparoscopy and LUS with the help of frozen section analysis to any doubtful metastatic site, peritoneal fluid and ascitic fluid analysis. Results: DL helped us to avoid needless laparotomy in 22.5% of patients, reducing its post-operative complications, hospital stay and cost. DL also helped us to do palliative management either in the form of gastric bypass or laparoscopic celiac plexus block. Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies.

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“…In a cohort of 90 subjects with pancreatic cancer, laparoscopic US concluded the resectability in 13 patients (14%), where laparoscopic analysis alone had led to vagueresults [8].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Role of Laparoscopy and Laparoscopic Ultrasound in Staging and in Palliation of Upper Gastro-Intestinal Malignancies: The Egyptian National Cancer Institute Experience

Gad¹,

Gareer²,

El-Malt³

et al. 2017

JCT

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show abstract

“…The yield of laparoscopy for the detection of metastatic disease, especially of small peritoneal lesions that have not been detected by imaging modalities, ranges from 15 to 46% (Jimenez et al, 2000;Menack et al, 2001;Minnard et al, 1998;Velasco et al, 1998;Liu & Traverso, 2005). Recent studies have shown lower yields for laparoscopy than for improved non invasive imaging modalities like multi detector CT.…”

Section: Laparoscopic Diagnosis/stagingmentioning

confidence: 99%

Laparoscopic Pancreatic Surgery

Jang¹

2012

Advances in Laparoscopic Surgery

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“…Some have advocated the routine use of laparoscopic ultrasonography to enhance the accuracy of the staging procedure with respect to the primary tumor relationship to the major blood vessels, the presence of enlarged peripancreatic lymph nodes or small deep liver metastasis [5] . In this setting, laparoscopic ultrasonography may identify additional disease in approximately 10% of patients [6,7] but whether it should be routinely or selectively used is controversial. Laparoscopic ultrasound probes are not widely available and thus the surgeon's familiarity with the findings is limited.…”

Section: Laparoscopic Techniquementioning

confidence: 99%

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Gaujoux

Allen

2010

WJGS

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Even after extensive preoperative assessment, staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease. Staging laparoscopy is associated with decreased postoperative pain, a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques. Current uses of staging laparoscopy include the following: (1) In the staging of pancreatic adenocarcinoma, laparoscopic staging allows for the identification of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and, in radiographically resectable cancer, may identify metastatic disease in 10%-15% of cases; (2) In colorectal liver metastases, selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients; (3) In hepatocellular carcinoma, laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors; and (4) In biliary tract malignancy, staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma. Because of the decreasing yield of SL secondary to improvements in imaging techniques, staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization. Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.

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Laparoscopic Ultrasound Enhances Standard Laparoscopy in the Staging of Pancreatic Cancer

Cited by 145 publications

References 25 publications

The Role of Laparoscopy and Laparoscopic Ultrasound in Staging and in Palliation of Upper Gastro-Intestinal Malignancies: The Egyptian National Cancer Institute Experience

The Role of Laparoscopy and Laparoscopic Ultrasound in Staging and in Palliation of Upper Gastro-Intestinal Malignancies: The Egyptian National Cancer Institute Experience

Laparoscopic Pancreatic Surgery

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

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