The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies

Holzman, Michael D.; Reintgen, Kathy L.; Tyler, Douglas S.; Pappas, Theodore N.

doi:10.1016/s1091-255x(97)80115-1

Cited by 59 publications

(39 citation statements)

References 29 publications

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“…The yield from laparoscopic assessment in identifying these patients will be dependent on both the quality of the radiological imaging and patient selection. Recent series [2,3,4,5, 22, 23]have reported resection rates in patients considered resectable on radiological assessment (number of patients actually resected/number of patients resectable on radiological assessment) of over 70%; correspondingly the yield from laparoscopy has decreased to 4–13% [2,3,4,5, 22]. In the current series (including 16% of patients with equivocal findings on contrast-enhanced computed tomography) the resection rate in patients considered resectable on radiological assessment was 68%; identification of unresectability on laparoscopic assessment of 15% of patients considered resectable on radiological assessment, data that are in keeping with other recent series.…”

Section: Discussionmentioning

confidence: 99%

“…The role of laparoscopic assessment (laparoscopy with or without intraoperative ultrasonography) in the preoperative staging of suspected pancreatic malignancy is controversial [1,2,3,4,5,6]. An initial report [1] suggested that laparoscopy could alter the management in up to 35% of patients by the detection of occult metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

“…An initial report [1] suggested that laparoscopy could alter the management in up to 35% of patients by the detection of occult metastatic disease. 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].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2005

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“…Although the ability of laparoscopy to improve preoperative detection of resectable periampullary cancer remains to be evaluated, preliminary studies are encouraging. 21,22 Conlon and colleagues 23 were able to increase the ability to predict resectability from 53% after CT staging to 88% by adding laparoscopy. A number of studies have also shown that laparoscopic ultrasonography can be added to regular laparoscopy to enhance its accuracy in staging patients with hepatobiliary and pancreatic malignancies.…”

mentioning

confidence: 99%

State‐of‐the‐art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

Morrin

Kruskal²,

Raptopoulos³

et al. 2001

J of Ultrasound Medicine

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AbbreviationsCT, computed tomography; CTA, computed tomographic angiography; PV, portal vein; SMA, superior mesenteric artery; SMV, superior mesenteric vein; SV, splenic vein Article Objective. To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullary cancer is unresectable because of either distant metastasis or local vascular involvement. The advent of gray scale and color Doppler ultrasonography has improved the ability of ultrasonography to detect vascular involvement. Methods. Twenty-three consecutive patients with periampullary cancer were enrolled for prospective staging of their disease by comparing helical computed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesenteric vein, splenic vein, and superior mesenteric artery involvement was graded 0 to 4, grade 0 being no vascular involvement and grade 4 being total occlusion of the vessel. Agreement between ultrasonography and computed tomographic angiography for determining vascular involvement was measured by χ 2 analysis. Results. Two patients (9%) were excluded because excessive overlying bowel gas hampered the ability of ultrasonography to visualize the pancreas. For the remaining 21 patients, there was significant agreement between ultrasonography and computed tomographic angiography for detecting vascular involvement in all vessels (P < .001; portal vein, κ = 0.67; superior mesenteric vein, κ = 0.67; splenic vein, κ = 0.85; and superior mesenteric artery, κ = 0.59). Ultrasonography was in agreement with computed tomographic angiography in all cases of unresectability. Both modalities were equally poor in preoperatively showing lymphadenopathy and metastases. Conclusions. Provided that there is adequate visualization on ultrasonography of the head of the pancreas in the periampullary region, then state-of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detecting the unresectability of periampullary cancer. If performed as the initial investigation and the region of the pancreatic head is clearly shown, and if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.

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“…At that time (1978) they reported success in detecting occult metastases in 75% of their evaluated patients who were all staged before by a CT scan [19]. Since then laparoscopy has been performed separately or in combination with a possible laparotomy [9, 12, 21, 22, 23]. …”

Section: Staging Laparoscopy: In Which Patients Should It Be Performed?mentioning

confidence: 99%

Staging Laparoscopy and Its Indications in Pancreatic Cancer Patients

Hennig¹,

Tempia-Caliera²,

Hartel³

et al. 2002

Dig Surg

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Background: Laparoscopy has become a popular and widespread surgical technique. An important goal in the treatment of patients with pancreatic cancer is to avoid any unnecessary procedure. Laparoscopy has been suggested as a routine tool for staging in order to prevent unnecessary laparotomies in these patients. Methods: In this article we present our experience regarding the value of laparoscopic staging and review the literature on this topic. Results and Conclusion: A direct and conclusive comparison of the controversial literature is difficult because of different study designs. Inconsistent use of high-quality CT scans significantly affects the results. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a state-of-the-art CT scan has been performed previously. Therefore, we conclude that routine diagnostic laparoscopy is not justified in all patients with pancreatic cancer. Rather, selective use is appropriate, especially in patients in whom ascites is an indirect sign of peritoneal metastases, or if liver metastases cannot be surely excluded preoperatively. This approach is cost-effective and limits diagnostic laparoscopy to a subgroup of patients in whom a laparotomy can be avoided.

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The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies

Cited by 59 publications

References 29 publications

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

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

State‐of‐the‐art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

Staging Laparoscopy and Its Indications in Pancreatic Cancer Patients

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