Laparoscopic ultrasound: a surgical �must� for second line intra-operative evaluation of pancreatic cancer resectability

Piccolboni, P; Settembre, A.; Angelini, Pierluigi; Esposito, Francesco; Palladino, S; Corcione, Francesco

doi:10.11138/gchir/2015.36.1.005

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…However, study cohorts were small (n < 50), and only few patients were diagnosed with occult distant disease (one and two cases, respectively). 16,17 The outcomes of our study are more in accordance with the results of a larger study in which the role of intraoperative ultrasound during exploratory laparotomy was investigated. In less than 1% of 470 patients the liver metastases found by intraoperative ultrasound resulted in a significant change of management.…”

Section: Discussionsupporting

confidence: 86%

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

Looijen

Pranger

Jong

et al. 2018

Journal of Gastrointestinal Surgery

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Background This study aimed to evaluate the additional value of laparoscopic ultrasound (LUS) to staging laparoscopy (SL) for detecting occult liver metastases in patients with potentially resectable pancreatic head cancer. Methods A retrospective cohort study was performed including all patients who underwent SL and LUS between 2005 and 2016. LUS was performed during SL to detect liver metastases not found by preoperative imaging or visual inspection of the liver. Results Out of 197 patients, visual inspection during SL detected distant metastases in 29 (14.7%) patients. LUS was performed in 127 patients, revealing 3 additional liver metastases. The proportion of patients with unresectable disease after SL and negative LUS was 32.3%, which was similar to 36.6% of patients with unresectable disease after SL without LUS (difference 4.3%; 95% CI − 13-23%; P = 0.61). Sensitivity, specificity, and positive and negative predictive values of LUS to detect liver metastases were 30, 100, 100, and 94%, respectively. The proportion of patients with distant metastases diagnosed at SL significantly increased over time (P = 0.031). Conclusion The routine use of LUS during SL for patients with potentially resectable pancreatic head cancer cannot be recommended. Imaging should be repeated when significant delay occurs between index CT and the scheduled surgery.

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Section: Discussionsupporting

confidence: 86%

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

Looijen

Pranger

Jong

et al. 2018

Journal of Gastrointestinal Surgery

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“…Previous studies on IOUS in pancreatic cancer have mainly focused on the detection of metastases, rather than the evaluation of vascular involvement. [21][22][23][24] A previous prospective monocenter study by our group suggested that IOUS could be useful, as it downstaged the local resectability status in one-third of 38 patients with LAPC after induction chemotherapy. 14 Another monocenter study by our group included 31 patients with pancreatic ductal adenocarcinoma (PDAC), or periampullary cancer, and indicated more accurate assessment of vascular involvement by IOUS, compared with conventional imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Ultrasound During Surgical Exploration in Patients with Pancreatic Cancer and Vascular Involvement (ULTRAPANC): A Prospective Multicenter Study

et al. 2023

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Background Determining the resectability of pancreatic cancer with vascular involvement on preoperative computed tomography imaging remains challenging, especially following preoperative chemotherapy and chemoradiotherapy. Intraoperative ultrasound (IOUS) may provide real-time additional information, but prospective multicenter series confirming its value are lacking. Patients and Methods This prospective multicenter study included patients undergoing surgical exploration for pancreatic cancer with vascular involvement. All patients underwent IOUS at the start of explorative laparotomy. Primary outcomes were resectability status as defined by the National Comprehensive Cancer Network and the extent of vascular involvement. Results Overall, 85 patients were included, of whom 74 (87%) were post preoperative chemotherapy, and mostly following FOLFIRINOX regimen (n = 57; 76%). On the basis of preoperative imaging, 34 (40%) patients were staged as resectable (RPC), 32 (38%) borderline resectable (BRPC), and 19 (22%) locally advanced pancreatic cancer (LAPC). IOUS changed the resectability status in 32/85 (38%) patients (p < 0.001), including 8/19 (42%) patients with LAPC who were downstaged (4 to BRPC, 4 to RPC), and 22/32 (69%) patients with BRPC who were downstaged to RPC. Among patients with presumed superior mesenteric artery (SMA) involvement, 20/28 (71%) had no SMA involvement on IOUS. In 15 of these 20 patients a pancreatic resection was performed, all with R0 SMA margin. Conclusion IOUS during surgical exploration for pancreatic cancer and vascular involvement downstaged the resectability status in over one-third of patients, which could facilitate progress during surgical exploration. This finding should be confirmed by larger studies, including detailed pathology assessment. Trial Registrationwww.trialregister.nl (NL7621).

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“…Routine use of laparoscopic ultrasound during staging laparoscopy has the potential of finding small metastatic lesions that can be missed by routine cross-sectional imaging or visual inspection during laparoscopy. When used in conjunction with laparoscopy, laparoscopic ultrasound can help in evaluation of primary tumors, peripancreatic vascular anatomy, detect small occult metastatic lesions and hence, change the surgical approach and prevent unnecessary radical surgery[ 75 - 79 ].…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

Current controversies and advances in the management of pancreatic adenocarcinoma

Zeeshan¹,

Ramzan²

2021

WJGO

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Pancreatic adenocarcinoma is a lethal disease with a mortality rate that has not significantly improved over decades. This is likely due to several challenges unique to pancreatic cancer. Most patients with pancreatic cancer are diagnosed at a late stage of disease due to the lack of specific symptoms prompting an early investigation. A small subset of patients who are diagnosed at an early stage have a better chance at survival with curative surgical resection, but most patients still succumb to the disease in a few years. The dismal overall prognosis is due to suspected micro-metastasis at an early stage. Due to this reason, there is a recent interest in treating all patients with pancreatic cancers with systemic therapy upfront (including the ones that are surgically resectable). This approach is still not the standard of care due to the lack of robust prospective data available. Recent advancements in treatment regimens of chemotherapy, radiation and immunotherapy have improved the overall short-term survival but the long-term survival still remains poor. Novel approaches in diagnosis and treatment have shown promise in clinical studies but long-term clinical data is lacking. The following manuscript presents an overview of the epidemiology, diagnosis, staging, recent advances, novel approaches and controversies in the management of pancreatic adenocarcinoma.

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Laparoscopic ultrasound: a surgical �must� for second line intra-operative evaluation of pancreatic cancer resectability

Cited by 3 publications

References 12 publications

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

Intraoperative Ultrasound During Surgical Exploration in Patients with Pancreatic Cancer and Vascular Involvement (ULTRAPANC): A Prospective Multicenter Study

Current controversies and advances in the management of pancreatic adenocarcinoma

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