Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours

Abstract

Laparoscopy and laparoscopic ultrasound have been validated previously as staging tools for pancreatic cancer. The aim of this study was to identify if assessment of vascular involvement with abdominal computed tomography (CT) would allow refinement of the selection criteria for laparoscopy and laparoscopic ultrasound (LUS). The details of patients staged with LUS and abdominal CT were obtained from the unit's pancreatic cancer database. A CT grade (O, A-F) of vascular involvement was recorded by a single radiologist. Of 152 patients, who underwent a LUS, 56 (37%) had unresectable disease. Three of 26 (12%) patients with CT grade O, 27 of 88 (31%) patients with CT grade A to D, 17 of 29 (59%) patients with CT grade E and all nine patients with CT grade F were found to have unresectable disease. In all, 24% of patients with tumours o3 cm were found to have unresectable disease. In those patients with tumours considered unresectable, local vascular involvement was found in 56% of patients and vascular involvement with metastatic disease in 17%, while 20% of patients had liver metastases alone and 5% had isolated peritoneal metastases. The remaining patient was deemed unfit for resection. Selective use of laparoscopic ultrasound is indicated in the staging of periampullary tumours with CT grades A to D.

Staging for locally advanced pancreatic cancer

“…As a result several groups recommend diagnostic laparoscopy in combination with or without laparoscopic ultrasonography as a standard procedure in the staging of all patients with resectable as well as unresectable pancreatic cancer. [9,10] However recent studies using high quality CT-scanning in resectable pancreatic cancer patients revealed that only a small percentage of these patients would benefit from a routine diagnostic laparoscopy. [11,12] …”

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.…”

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

“…Overall, the results of these studies have suggested that LUS may improve the sensitivity to detect liver metastases. [9][10][11][12][13][14][15] Few studies have investigated the additional value of LUS compared to modern preoperative imaging modalities. However, study cohorts were small (n < 50), and only few patients were diagnosed with occult distant disease (one and two cases, respectively).…”