A critical appraisal of laparoscopic staging in hepatobiliary and pancreatic malignancy

Potter, Michael W.; Shah, Shimul A.; McEnaney, Patrick M.; Chari, Ravi S.; Callery, Mark P.

doi:10.1016/s0960-7404(01)00005-6

Cited by 17 publications

(7 citation statements)

References 32 publications

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“…Unfortunately, despite increasingly sophisticated chemotherapy and radiation regimens, the only truly curative option for these patients is complete surgical resection of localized disease, and the vast majority of patients are not candidates for resection at the time of diagnosis because of either distant metastatic disease or significant involvement of the major central mesenteric arterial and venous vasculature. Accurate staging before surgery is critical, because a nontherapeutic laparotomy (as a result of unexpectedly discovering metastatic disease or a locally advanced tumor at surgery) subjects patients to unnecessary morbidity, potentially delays the initiation of chemotherapy, and incurs an unnecessary monetary cost [2, 3]. As a result, accurate preoperative staging via imaging is critical in determining which patients truly have localized disease and will be appropriate candidates for surgical resection.…”

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confidence: 99%

Impact of the Time Interval Between MDCT Imaging and Surgery on the Accuracy of Identifying Metastatic Disease in Patients With Pancreatic Cancer

Raman

Reddy

Weiss

et al. 2015

American Journal of Roentgenology

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Objective Pancreatic adenocarcinoma is a rapidly progressive malignancy characterized by its tendency for early metastatic spread. MDCT is the primary diagnostic modality for the preoperative staging of patients with pancreatic cancer, with an accuracy established in multiple studies. However, for a variety of reasons, there is often a prolonged interval between staging MDCT and the surgical intervention. This study examines the relationship between the interval between imaging and surgery and the accuracy of MDCT in determining the presence or absence of metastatic disease at surgery in patients with pancreatic cancer. Materials and Methods Patients were identified who had undergone surgery for pancreatic cancer at our institution with a dedicated preoperative pancreas-protocol MDCT performed in our department. Findings from the preoperative MDCT report were correlated with the operative findings, as well as the time between imaging and surgery. Results Two hundred ninety-two MDCT scans were performed on 256 patients who underwent exploration for pancreatic adenocarcinoma. The patients had a median age of 67 years (range, 30–95 years), and 51.6% (132/256) were male. The median time between MDCT and surgical exploration was 15.5 days (range, 1–198 days). MDCT correctly predicted the absence of metastatic disease at surgery in 233 of 274 (85.0%) studies. MDCT was more accurate in predicting the absence of metastatic disease if the study was performed within 25 days of surgery than it was if the study was performed within more than 25 days of surgery (89.3% vs 77.0%; p = 0.0097). Furthermore, regression models showed that the negative predictive value of a given MDCT significantly decreased after approximately 4 weeks. Conclusion MDCT is an accurate method to stage patients with pancreatic cancer, but its accuracy in excluding distant metastatic disease depreciates over time. Patients should undergo a repeat MDCT within 25 days of any planned definitive operative intervention for pancreatic cancer to avoid unexpectedly finding metastatic disease at surgery.

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confidence: 99%

Impact of the Time Interval Between MDCT Imaging and Surgery on the Accuracy of Identifying Metastatic Disease in Patients With Pancreatic Cancer

Raman

Reddy

Weiss

et al. 2015

American Journal of Roentgenology

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“…Among these 4744 patients, 3 cases with bile duct injury were managed via primary repair and T-tube placement. AP presentation included specific abdominal pain with increase in serum amylase level 3 times greater than reference range [6]. Ranson criteria were used to describe severity of illness; score below 3 reflects mild illness, while higher scores indicate severe disease [7].…”

Section: Methodsmentioning

confidence: 99%

Acute Biliary Pancreatitis in Cholecystectomised Patients

Çiftçi

Anuk

2017

North Clin Istanbul

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OBJECTIVE:The present study is an evaluation of cases of acute biliary pancreatitis that developed subsequent to cholecystectomy.METHODS:Total of 44 patients were assessed in this retrospective study. Demographic characteristics, severity of illness, time elapsed between cholecystectomy and development of pancreatitis, whether endoscopic sphincterotomy (ES) was performed, surgical procedure used, duration of hospitalization, and mortality data were recorded.RESULTS:Mean age of all patients was 60.14±16.4 years (range: 20–85 years), and female:male ratio was 28:16. Mean length of time elapsed between cholecystectomy and development of acute pancreatitis was 80.6 months (range: 5–230 months). Gallstones and biliary sand were found in the choledochi of 36 patients upon endoscopic retrograde cholangiopancreatography (ERCP), but not observed in the remaining 8 patients. ES was performed and material was extracted in 32 of the 36 patients, but stone extraction was unsuccessful in 4 cases; 3 patients underwent open surgery with choledochus exploration and 1 patient died. Excluding this patient, mean duration of hospitalization was 7.5±2.5 days.CONCLUSION:Stones in bile ducts may remain asymptomatic for long periods after cholecystectomy. However, some stones trigger acute pancreatitis months or years after cholecystectomy, causing risk of mortality. ERCP and ES are the standard treatments. If these are unsuccessful, the choledochus may be explored via open or laparoscopic surgery.

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“…In BR patients with PC undergoing restaging, the probability of unresectability was 0.16 or 16% (0.10 from peritoneal metastases and 0.06 from locally invasive disease) . The probability of exclusion from resection in the SF group was 0.35 or 35% (range: 0.30–0.60) . The probability of palliative intervention was assumed to be 0.10 (range: 0.0–0.40).…”

Section: Methodsmentioning

confidence: 99%

Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

Jayakrishnan

Hasan²,

Groeschl³

et al. 2015

HPB

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A critical appraisal of laparoscopic staging in hepatobiliary and pancreatic malignancy

Cited by 17 publications

References 32 publications

Impact of the Time Interval Between MDCT Imaging and Surgery on the Accuracy of Identifying Metastatic Disease in Patients With Pancreatic Cancer

Impact of the Time Interval Between MDCT Imaging and Surgery on the Accuracy of Identifying Metastatic Disease in Patients With Pancreatic Cancer

Acute Biliary Pancreatitis in Cholecystectomised Patients

Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

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