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

Abstract

Background/Aims: Staging laparoscopy for suspected pancreatic neoplasia is not widely accepted due to its low yield. The aim of this study was to determine if serum carbohydrate antigen (CA19-9) levels could be used to improve the selection of patients for staging laparoscopy. Methods: The data from a prospectively collected database (1997–2004) with 159 patients who had computed tomography-predicted resectable disease and who had undergone laparoscopic staging were analysed to determine if a low preoperative CA19-9 level (≤150 kU/l, or ≤300 kU/l with a bilirubin >35 µmol/l) identified patients in whom laparoscopy was not useful. Results: The CA19-9 level was >150 kU/l in 96 patients of whom 75 (78%) were considered resectable following laparoscopic assessment. There were 63 patients with a CA19-9 ≤150 kU/l of whom 60 (95%) were considered resectable following laparoscopic assessment. The sensitivity, specificity, positive predictive value and negative predictive value for CA19-9 ≤150 kU/l in predicting that laparoscopic assessment would judge patients as resectable were 44, 88, 95 and 22%, respectively. A cut-off level of ≤300 kU/l in patients with a bilirubin >35 µmol/l produced values of 30, 94, 94 and 28%, respectively. By using CA19-9 ≤150 kU/l, laparoscopy could have been avoided in 40% of patients, increased to 55% of patients with adjustment for the presence of jaundice; concomitantly, the yield from laparoscopy would have been increased from 15 to 22 and 25%, respectively. Conclusion: Use of serum CA19-9 levels would increase the efficiency of laparoscopic staging in patients with suspected pancreatic malignancy.

Preoperative CA19-9 Levels and Lymph Node Ratio Are Independent Predictors of Survival in Patients with Resected Pancreatic Ductal Adenocarcinoma

“…Adopting a level of >150 kU/l targets a patient population for whom the diagnostic yield from staging laparoscopy is maximised in terms of detecting occult metastatic disease [9]. One study demonstrated marked variability in the pattern of CA19-9 change following preoperative resolution of obstructive jaundice in cases of pancreatic adenocarcinoma, with levels falling in some cases and increasing in others [10].…”

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

“…[24][25][26][27] A cancer antigen 19-9 level of 215 U/ml was proposed to select high-risk patients. 24 If this cutoff point would have been applied to the current series, about half of the patients with distant metastases would unfairly be excluded for SL (data not shown).…”

The Role of Laparoscopy in Advanced Pancreatic Cancer Diagnosis

“…Several authors have demonstrated that laparoscopy is both safe and feasible to better assess resectability in pancreatic cancer patients before resorting to an open resective procedure, especially when associated with laparoscopic ultrasound [12,13,14,15,16,17,18]. Moreover, other authors have reported that such an approach can be adopted on a routine basis [19,20,21,22,23].…”

“…The role of laparoscopy and laparoscopic US in staging pancreatic cancer is well established [12,13,14,15,16,17,18], and the procedure is considered routine before exploratory laparotomy for pancreatic resection by several high-volume centers [19,20,21,22,23]. …”