Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer

Allen, Victoria B; Gurusamy, Kurinchi Selvan; Takwoingi, Yemisi; Kalia, Amun; Davidson, Brian R

doi:10.1002/14651858.cd009323.pub2

Cited by 89 publications

(68 citation statements)

References 141 publications

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“…In previous studies, the incidence of futile surgery in patients undergoing scheduled laparotomy has been reported to be 10–41%, which is similar to that observed in our cohort (10.3%). Several factors were previously reported to be associated with the risk of futile surgery, including tumor size, serum CA 19‐9 level, platelet–lymphocyte ratio, platelet count, neutrophil–lymphocyte ratio, CA 19‐9–bilirubin ratio, C‐reactive protein level, and weight loss . Among these, tumor size and serum CA 19‐9 level have been the most consistent predictors of futile surgery in previous studies …”

Section: Discussionsupporting

confidence: 91%

Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Lee

Hwang

et al. 2019

J of Gastro and Hepatol

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Background and Aim The aim of this study is to identify the predictive factors for futile surgery in patients with radiologically resectable or borderline resectable pancreatic cancer and to develop a prediction model. Methods This retrospective study included patients who underwent pancreatic surgery for pancreatic cancer between 2006 and 2017. To identify independent risk factors for futile surgery, logistic regression and random forest analyses were performed in the training cohort, based on which a nomogram was established. The predictive accuracy and discriminative ability of the nomogram were validated in the validation cohort. Results Of 389 patients who underwent pancreatic surgery, the laparotomy was futile in 40 patients (10.3%). In the training cohort, the univariate and multivariate logistic regression analyses revealed that serum carbohydrate antigen 19‐9 level of ≥ 150 U/mL (P = 0.003), the presence of suspicious lymph node (P = 0.013), and more extensive peripancreatic tumor infiltration (P < 0.001) were independent predictive factors for futile surgery. The bootstrap‐corrected concordance index of the nomogram was high in the training cohort, 0.826 with a 95% confidence interval of 0.745–0.907. This model also showed a good discriminative performance in the validation cohort, with a concordance index of 0.831. Conclusions We established and validated a novel nomogram that predicts the risk of futile surgery due to occult distant metastasis in patients with radiologically resectable or borderline resectable pancreatic cancer.

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Section: Discussionsupporting

confidence: 91%

Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Lee

Hwang

et al. 2019

J of Gastro and Hepatol

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“…In the paper of Allen et al [7], the false positive could be reduced from 40% to 17% using laparoscopy. Comparable findings are found in our meta-analysis when using only CT.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Somers

Bipat

2017

Eur Radiol

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ObjectiveTo obtain a summary positive predictive value (sPPV) of contrast-enhanced CT in determining resectability.MethodsThe MEDLINE and EMBASE databases from JAN2005 to DEC2015 were searched and checked for inclusion criteria. Data on study design, patient characteristics, imaging techniques, image evaluation, reference standard, time interval between CT and reference standard, and data on resectability/unresectablity were extracted by two reviewers. We used a fixed-effects or random-effects approach to obtain sPPV for resectability. Several subgroups were defined: 1) bolus-triggering versus fixed-timing; 2) pancreatic and portal phases versus portal phase alone; 3) all criteria (liver metastases/lymphnode involvement/local advanced/vascular invasion) versus only vascular invasion as criteria for unresectability.ResultsTwenty-nine articles were included (2171 patients). Most studies were performed in multicentre settings, initiated by the department of radiology and retrospectively performed. The I2-value was 68%, indicating heterogeneity of data. The sPPV was 81% (95%CI: 75-86%). False positives were mostly liver, peritoneal, or lymphnode metastases. Bolus-triggering had a slightly higher sPPV compared to fixed-timing, 87% (95%CI: 81-91%) versus 78% (95%CI: 66-86%) (p = 0.077). No differences were observed in other subgroups.ConclusionsThis meta-analysis showed a sPPV of 81% for predicting resectability by CT, meaning that 19% of patients falsely undergo surgical exploration.Key points• Predicting resectability of pancreatic cancer by CT is 81% (95%CI: 75-86%).• The percentage of patients falsely undergoing surgical exploration is 19%.• The false positives are liver metastases, peritoneal metastases, or lymph node metastases Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4708-5) contains supplementary material, which is available to authorized users.

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“…Although it is still a topic of controversy in the surgical literature, it has been well described that diagnostic laparoscopy has a higher sensitivity for metastatic disease than does CT and can visualize metastases that are not visible on conventional imaging modalities. In cases for which a repeat preoperative CT is absolutely impossible, for either logistic or financial reasons, perhaps a diagnostic laparoscopy immediately before a formal laparotomy for resection might be considered [22]. Taken as a whole, these data strongly suggest that, to have the most accurate distant staging for pancreatic adenocarcinoma, MDCT should be performed within 25 days of any planned definitive therapy, especially surgical exploration with the intent to resect.…”

Section: Discussionmentioning

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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Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer

Cited by 89 publications

References 141 publications

Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

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

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