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

Abstract

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.

Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

“…Similarly, its relevance remains under debate. [18] Nevertheless, we wanted to highlight that 12% of patients in our series who underwent an exploratory laparoscopy were nally found to have a contraindication to resection intraoperatively (with a "short" delay from laparoscopy to exploration of 18 days). This suggested that negative exploratory laparoscopy did not systematically imply a resection, mainly because it is di cult to explore major vasculature involvement in this way.…”

Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

“…Similarly, its relevance remains under debate. [19] Nevertheless, we wanted to highlight that 12% of patients in our series who underwent an exploratory laparoscopy were nally found to have a contraindication to resection intraoperatively (with a "short" delay from laparoscopy to exploration of 18 days). This suggested that negative exploratory laparoscopy did not systematically imply a resection, mainly because it is di cult to explore major vasculature involvement in this way.…”

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

“…However, laparoscopy is not routinely performed worldwide and a recent large series reported that about 10% of patients underwent this procedure [18]. Similarly, its relevance remains under debate [19]. Nevertheless, we wanted to highlight that 12% of patients in our series who underwent an exploratory laparoscopy were finally found to have a contraindication to resection intraoperatively (with a "short" delay from laparoscopy to exploration of 18 days).…”