Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate

León, Enrique Luque-de; Tsiotos, Gregory G.; Balsiger, Bruno M.; Barnwell, John M.; Burgart, Larry J.; Sarr, Michael G.

doi:10.1016/s1091-255x(99)80018-3

Cited by 41 publications

(26 citation statements)

References 27 publications

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“…Bypass procedures can be reserved for patients in whom stenting fails [32][33][34][35][36]. A single-institution study of 155 laparoscopically staged patients, 40 with locally advanced disease and 115 with metastatic disease, assessed the need for a surgical bypass procedure.…”

Section: Obstructive Jaundicementioning

confidence: 99%

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Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

2003

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For these reasons, efforts at identifying and treating disease-related symptomatology are priorities. This update overviews symptom management, supportive care strategies, and both standard and emerging palliative chemotherapy options. The incorporation of molecularly targeted therapies into treatment of metastatic pancreatic cancer is reviewed as well. These strategies are of relevance to internists, gastroenterologists, oncologists, and other specialists who care for patients with pancreatic cancer.

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Section: Obstructive Jaundicementioning

confidence: 99%

“…The Oncologist 2003;8: [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The expected number of new cases of pancreatic cancer in 2002 within the article should read 30,300 rather than 33,000. The authors would like to thank Dr. Tom Cole for bringing this to their attention.…”

mentioning

confidence: 99%

Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

2003

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“…Furthermore, research concerning neo-adjuvant protocols for locally advanced cancers makes accurate staging bossy. [4] Laparoscopic analysis can envisage the primary tumor, recognize hepatic metastases, detect regional nodal metastases and perceive small-volume peritoneal disease unnoticed by other non-invasive staging modalities, such as computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasonography (US). The technique also eases obtaining biopsy specimens and aspiration cytology.…”

Section: Introductionmentioning

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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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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“…Whilst pancreatic resection for carcinoma is associated with a 5-year survival of 10–20% and perhaps more with adjuvant treatment [3, 4], resection is neither feasible nor possible in the majority, for whom median survival is usually less than 6 months [5]. Accurate determination of both the operability and resectability of suspected pancreatic neoplasia can increase the number of patients undergoing an appropriate resection, and reduce the number of patients undergoing major abdominal surgery for whom effective non-surgical palliation is preferable [5, 6, 7]. Other advantages of accurate assessment include the provision of precise clinical advice without the need for open surgical assessment, early institution of palliative care, and more efficient use of surgical resources.…”

Section: Introductionmentioning

confidence: 99%

“…Only three studies have had at least 100 patients undergoing investigation, two using laparoscopy [15, 16]and only one involving laparoscopic ultrasound [19]. There have even been a number of phantom studies in which neither laparoscopy nor laparoscopic ultrasound were used [7, 10, 12, 28]. This study was undertaken to assess the usefulness of laparoscopy with laparoscopic ultrasound in a large series of patients who had already undergone dual-phase spiral CT in the assessment of suspected pancreatic and peri-ampullary neoplasia.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2004

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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.

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Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate

Cited by 41 publications

References 27 publications

Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

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

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

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