Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: An indirect evaluation of the usefulness of laparoscopy

Maire, Frédérique; Sauvanet, Alain; Trivin, F.; Hammel, Pascal; O’Toole, Dermot; Palazzo, Laurent; Vilgrain, Valérie; Belghiti, Jacques; Ruszniewski, Philippe; Lévy, Philippe

doi:10.1159/000079617

Cited by 46 publications

(31 citation statements)

References 38 publications

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“…However, since pancreatic cancer patients seldom exhibit disease-specific symptoms until late in the course of the disease, very few patients (<15-20%) have resectable disease by the time the diagnosis is made (1,2). A proportion of patients thought to be resectable by imaging studies will be found to have metastatic or locally unresectable disease at surgery; the proportion varies from 15% to 50% depending on quality of pre-operative imaging (3)(4)(5). Finally, a subset of patients undergoing curative resection (up to 30%) will have positive resection margins (6), reflecting incomplete resection.…”

Section: Why Is Pancreatic Cancer Mortality So High?mentioning

confidence: 99%

Detecting Early Pancreatic Cancer: Problems and Prospects

Chari

2007

Seminars in Oncology

150

133

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Pancreatic cancer has a poor prognosis. Improving survival will require diagnosis of early pancreatic cancer which can be defined based on resectability, size or curability. Pancreatic cancer progresses from non-invasive precursor lesions to invasive cancer over a variable time period. Retrospective review of CT scans done prior to diagnosis suggests that pancreatic cancer resectability may be significantly improved if detected as few as 6 months before clinical diagnosis. Since pancreatic cancer is relatively uncommon, to allow cost-effective screening the populations will have to be enriched for the disease using two "sieves", first would be a population of subjects at higher than average risk of pancreatic cancer and the second sieve could be a characteristic phenotype among the members of the high-risk group, an abnormality seen on non-invasive imaging or a serologic marker of early pancreatic cancer. So far two high risk groups have been targets of screening for pancreatic cancer, viz., hereditary pancreatic cancer kindreds and new-onset diabetes. There is no serologic marker of early pancreatic cancer. Confirmation of diagnosis usually requires invasive procedures such endoscopic ultrasonography. Though much work still needs to be done, the developments in the field provide us with hope that screening for early pancreatic cancer could become a reality in the not-so-distant future.

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Section: Why Is Pancreatic Cancer Mortality So High?mentioning

confidence: 99%

Detecting Early Pancreatic Cancer: Problems and Prospects

Chari

2007

Seminars in Oncology

150

133

View full text Add to dashboard Cite

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2005

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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.

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“…It's specificity for differentiating a tumor from an inflammatory focus of chronic pancreatitis varies greatly from study (53% to 93%) [17]. It's sensitivity is insufficient for the diagnosis of peritoneal carcinoma or small metastases [18]. Histologically, a histological diagnosis should be obtained when non-surgical treatment is considered, as 10% of malignant tumors of the pancreas are not exocrine and all tumors of the pancreas are not malignant.…”

Section: Discussionmentioning

confidence: 99%