Resection for pancreatic cancer in the new millennium

Andrén‐Sandberg, Åke; Neoptolemos, John P.

doi:10.1159/000064710

Cited by 43 publications

(33 citation statements)

References 76 publications

(65 reference statements)

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“…In clinical routine the only limiting factor is the availability of EUS. However, treatment of patients with pancreatic disease is mostly restricted to specialized centers which offer EUS routinely to their patients, therefore EUS-FNA can be offered to the majority of patients [14][15][16].…”

Section: Confirmation Of Diagnosismentioning

confidence: 99%

Role of Endoscopic Ultrasound in the Diagnosis of Patients with Solid Pancreatic Masses

Kahl

Malfertheiner

2004

Dig Dis

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Endoscopic ultrasound (EUS) is the most sensitive imaging procedure for the detection of small solid pancreatic masses and is accurate in determining vascular invasion of the portal venous system. Even compared to the new CT techniques, EUS provides excellent results in preoperative staging of solid pancreatic tumors. Compared to helical CT techniques, EUS is less accurate in detecting tumor involvement of the superior mesenteric artery. EUS staging and EUS-guided FNA can be performed in a single-step procedure, to establish the diagnosis of cancer. There is no known negative impact of tumor cell seeding due to EUS-guided fine needle aspiration (FNA). Without FNA, EUS and additional methods are not able to reliably distinguish between inflammatory and malignant masses.

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Section: Confirmation Of Diagnosismentioning

confidence: 99%

Role of Endoscopic Ultrasound in the Diagnosis of Patients with Solid Pancreatic Masses

Kahl

Malfertheiner

2004

Dig Dis

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“…Only 20% of patients suffering from pancreatic cancer are amenable to surgical resection at diagnosis [1,2,3,4]. Among unresectable neoplasms it is important to distinguish between ductal adenocarcinoma and other tumors that have different management modalities and prognoses, such as endocrine carcinoma or metastases of non-pancreatic primary tumors to the pancreas.…”

Section: Introductionmentioning

confidence: 99%

The Role of Laparoscopy in Advanced Pancreatic Cancer Diagnosis

et al. 2007

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Background/Aims: Histological diagnosis between ductal and endocrine carcinoma is imperative in patients with advanced and unresectable pancreatic malignancies because of the different treatment modalities and prognoses. Whenever percutaneous and endoscopic ultrasound-guided pancreatic fine needle aspiration (FNA) fails to obtain a diagnostic specimen, a laparoscopic approach may be employed. Methods: Between October 2002 and July 2004, 19 patients with demonstrated unresectable pancreatic cancer underwent laparoscopy to obtain a cytohistological diagnosis. Results: The mean operative time was 83 min. Laparoscopy showed the presence of liver metastases in 15 patients that were correctly diagnosed by preoperative imaging in only 8 cases (53%). Overall 5 pancreatic FNA and 16 liver and peritoneal biopsies were obtained. In 1 patient the procedure was abandoned due to hypercapnia. In 16 patients (84%) a cytohistological diagnosis was obtained. There were no mortalities. Conclusions: Laparoscopic biopsy of advanced unresectable pancreatic cancer is a feasible, safe and reliable procedure to obtain a cytohistological diagnosis whenever ultrasound-guided FNA fails.

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“…Pancreatic resection for suspected neoplasia requires extensive patient preparation, commitment of appropriate theatre staff and time, a major abdominal incision, intensive care support, and a long recovery including an inpatient stay not usually less than 2 weeks [1, 2]. Whilst pancreatic resection for carcinoma is associated with a 5-year survival of 10–20% and perhaps more with adjuvant treatment [3, 4], resection is neither feasible nor possible in the majority, for whom median survival is usually less than 6 months [5].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy and Laparoscopic Ultrasound in the Evaluation of Pancreatic and Periampullary Tumours

et al. 2004

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Background and Aims: The pre-operative determination of resectability of pancreatic and peri-ampullary neoplasia assists the selection of patients for surgical or non-surgical treatment. This study investigated whether the addition of laparoscopy with laparoscopic ultrasound to dual-phase helical CT could improve the accuracy of assessment of resectability. Patients and Methods: Prospective study of 305 patients referred to a single unit for consideration of pancreatic resection who underwent dual-phase helical CT scanning ± laparoscopy with laparoscopic ultrasound. Data were collected on patient demographics, CT findings, assessment of operability, laparoscopic assessment (LA), surgical procedures and histology. Results: LA was undertaken in 239/305 patients, 190 of whom were considered CT resectable, and 49 CT unresectable. Of the 190 CT resectable patients, LA correctly identified unresectability in 28 (15%: metastases in 15; vascular encasement in 6; anaesthesia for laparoscopy found 7 unfit for major resection) and incorrectly in 2 (vascular encasement), but did not identify unresectability in 33; LA correctly confirmed resectability in the remainder (prediction improved, χ² = 9.73, p < 0.01). Of the 49 CT unresectable patients, LA correctly identified resectability in 4, and incorrectly in 12, and correctly identified unresectability in the remaining 33. Sixty-six of the 305 patients did not undergo LA, of whom 23 underwent resection. Conclusion: When added to dual-phase helical CT, laparoscopy with laparoscopic ultrasound provides valuable information that significantly improves the selection of patients for surgical or non-surgical treatment.

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Resection for pancreatic cancer in the new millennium

Cited by 43 publications

References 76 publications

Role of Endoscopic Ultrasound in the Diagnosis of Patients with Solid Pancreatic Masses

Role of Endoscopic Ultrasound in the Diagnosis of Patients with Solid Pancreatic Masses

The Role of Laparoscopy in Advanced Pancreatic Cancer Diagnosis

Laparoscopy and Laparoscopic Ultrasound in the Evaluation of Pancreatic and Periampullary Tumours

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