Laparoscopy and Laparoscopic Ultrasound in the Evaluation of Pancreatic and Periampullary Tumours

Abstract

Background and Aims: The pre-operative determination of resectability of pancreatic and peri-ampullary neoplasia assists the selection of patients for surgical or non-surgical treatment. This study investigated whether the addition of laparoscopy with laparoscopic ultrasound to dual-phase helical CT could improve the accuracy of assessment of resectability. Patients and Methods: Prospective study of 305 patients referred to a single unit for consideration of pancreatic resection who underwent dual-phase helical CT scanning ± laparoscopy with laparoscopic ultrasound. Data were collected on patient demographics, CT findings, assessment of operability, laparoscopic assessment (LA), surgical procedures and histology. Results: LA was undertaken in 239/305 patients, 190 of whom were considered CT resectable, and 49 CT unresectable. Of the 190 CT resectable patients, LA correctly identified unresectability in 28 (15%: metastases in 15; vascular encasement in 6; anaesthesia for laparoscopy found 7 unfit for major resection) and incorrectly in 2 (vascular encasement), but did not identify unresectability in 33; LA correctly confirmed resectability in the remainder (prediction improved, χ² = 9.73, p < 0.01). Of the 49 CT unresectable patients, LA correctly identified resectability in 4, and incorrectly in 12, and correctly identified unresectability in the remaining 33. Sixty-six of the 305 patients did not undergo LA, of whom 23 underwent resection. Conclusion: When added to dual-phase helical CT, laparoscopy with laparoscopic ultrasound provides valuable information that significantly improves the selection of patients for surgical or non-surgical treatment.

Serum CA19-9 Measurement Increases the Effectiveness of Staging Laparoscopy in Patients with Suspected Pancreatic Malignancy

“…With improvements in contrast-enhanced computed tomography contemporary reports have reduced the number benefiting from preoperative laparoscopy to 4–13% [2,3,4,5, 7] and its usefulness has been questioned [2, 6]. Laparoscopic ultrasonography has the added advantage of being able to assess the parenchyma of the liver and provide information on local relationships of the tumour but the actual advantage remains in dispute [6,7,8,9,10,11,12,13]. This has led to suggestions for the selective use of laparoscopic assessment in those who are at higher risk of unresectable disease [6, 14].…”

The role of laparoscopy and laparoscopic ultrasound in the preoperative staging of pancreatico-biliary cancers – A meta-analysis

“…80% of articles extracted were review articles, whilst the remaining did not assess SL/LUS as staging modality. Of the remaining 41 articles, 12 studies did not satisfy the eligibility criteria; 22 were for potentially resectable PPC and 7 for PBC [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37] (Supplemental information, Table ST1 to attain pneumoperitoneum and were therefore excluded from our analysis. Therefore, a total of 2,827 patients with PPC and 478 patients with PBC, deemed potentially resectable on preoperative staging, were included for analysis.…”

“…In 12 patients with PPC, laparoscopic ultrasound examination was not feasible due to previous adhesions, making the staging procedure incomplete. Only 2 studies, clarified RM status and where RM was positive, they were included as false negative 11,32 .…”

“…However, 44 / 722 patients (6%) were given a trial of surgical resection, of these only 14 underwent curative surgery (false positive); suspected local vascular invasion (n=3 [11,13]) and metastases from neuroendocrine tumour M A N U S C R I P T…”

Laparoscopic Pancreatic Surgery

“…Studies comparing laparoscopy and laparoscopic ultrasound with radiological staging modalities have produced controversial results. However, several studies have found that laparoscopy and laparoscopic ultrasound are more accurate than contrastenhanced CT at determining T stage (John et al, 1999;Doran et al, 2004).…”