The Role of Diagnostic Laparoscopy in Pancreatic and Periampullary Malignancies

Friess, Helmut; Kleeff, Jörg; Silva, Juan Carlos; Sadowski, Ch.; Baer, H. U.; Büchler, Markus W.

doi:10.1016/s1072-7515(98)00100-8

Cited by 128 publications

(91 citation statements)

References 34 publications

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“…The yield from laparoscopic assessment in identifying these patients will be dependent on both the quality of the radiological imaging and patient selection. Recent series [2,3,4,5, 22, 23]have reported resection rates in patients considered resectable on radiological assessment (number of patients actually resected/number of patients resectable on radiological assessment) of over 70%; correspondingly the yield from laparoscopy has decreased to 4–13% [2,3,4,5, 22]. In the current series (including 16% of patients with equivocal findings on contrast-enhanced computed tomography) the resection rate in patients considered resectable on radiological assessment was 68%; identification of unresectability on laparoscopic assessment of 15% of patients considered resectable on radiological assessment, data that are in keeping with other recent series.…”

Section: Discussionmentioning

confidence: 99%

“…The role of laparoscopic assessment (laparoscopy with or without intraoperative ultrasonography) in the preoperative staging of suspected pancreatic malignancy is controversial [1,2,3,4,5,6]. An initial report [1] suggested that laparoscopy could alter the management in up to 35% of patients by the detection of occult metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

“…An initial report [1] suggested that laparoscopy could alter the management in up to 35% of patients by the detection of occult metastatic disease. With improvements in contrast-enhanced computed tomography contemporary reports have reduced the number benefiting from preoperative laparoscopy to 4–13% [2,3,4,5, 7] and its usefulness has been questioned [2, 6]. Laparoscopic ultrasonography has the added advantage of being able to assess the parenchyma of the liver and provide information on local relationships of the tumour but the actual advantage remains in dispute [6,7,8,9,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

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Serum CA19-9 Measurement Increases the Effectiveness of Staging Laparoscopy in Patients with Suspected Pancreatic Malignancy

et al. 2005

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Background/Aims: Staging laparoscopy for suspected pancreatic neoplasia is not widely accepted due to its low yield. The aim of this study was to determine if serum carbohydrate antigen (CA19-9) levels could be used to improve the selection of patients for staging laparoscopy. Methods: The data from a prospectively collected database (1997–2004) with 159 patients who had computed tomography-predicted resectable disease and who had undergone laparoscopic staging were analysed to determine if a low preoperative CA19-9 level (≤150 kU/l, or ≤300 kU/l with a bilirubin >35 µmol/l) identified patients in whom laparoscopy was not useful. Results: The CA19-9 level was >150 kU/l in 96 patients of whom 75 (78%) were considered resectable following laparoscopic assessment. There were 63 patients with a CA19-9 ≤150 kU/l of whom 60 (95%) were considered resectable following laparoscopic assessment. The sensitivity, specificity, positive predictive value and negative predictive value for CA19-9 ≤150 kU/l in predicting that laparoscopic assessment would judge patients as resectable were 44, 88, 95 and 22%, respectively. A cut-off level of ≤300 kU/l in patients with a bilirubin >35 µmol/l produced values of 30, 94, 94 and 28%, respectively. By using CA19-9 ≤150 kU/l, laparoscopy could have been avoided in 40% of patients, increased to 55% of patients with adjustment for the presence of jaundice; concomitantly, the yield from laparoscopy would have been increased from 15 to 22 and 25%, respectively. Conclusion: Use of serum CA19-9 levels would increase the efficiency of laparoscopic staging in patients with suspected pancreatic malignancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum CA19-9 Measurement Increases the Effectiveness of Staging Laparoscopy in Patients with Suspected Pancreatic Malignancy

et al. 2005

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“…Friess et al [22]analyzed the impact of SL in pancreatic and periampullary cancer and found out that only 10% of the patients will benefit from laparoscopy [23]. With the help of LUS tumors of the pancreas can be precisely defined.…”

Section: Assessment Of Curability and Resectability According To Lapamentioning

confidence: 99%

Is There Additional Information from Laparoscopic Ultrasound in Tumor Staging?

2002

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Accurate preoperative staging of gastrointestinal malignancies is of major importance in the decision for adequate stage-related therapy. There is evidence that laparoscopy in combination with laparoscopic ultrasound is more accurate in the detection of intra-abdominal metastases than conventional preoperative imaging. Staging laparoscopy in combination with laparoscopic ultrasound is a minimally invasive technique that reveals intra-abdominal disseminated tumor spread and local tumor extent. Therefore laparoscopic ultrasound is an ideal adjunct to laparoscopy because this technique may compensate for the lack of tactile feedback with laparoscopic instruments. Color-coded Doppler imaging can be very valuable for the assessment of resectability in patients with pancreatic cancer. Current data confirm that laparoscopic ultrasound is capable of enhancing the accuracy of staging laparoscopy. Compared to standard laparoscopy, a combination of both techniques markedly increases the sensitivity of staging laparoscopy in the determination of unresectable disease. This is of major importance in the assessment of occult liver metastases and lymph node involvement. Laparoscopic ultrasonography improves the diagnostic accuracy compared to conventional imaging techniques and should be considered as integral part of staging laparoscopy.

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“…Laparoscopy can improve tumour staging but its value for the determination of resectability is questioned. In pancreatic cancer detection of metastatic lesions by laparoscopy has been reported in 10% to 35% [21][22][23]. The value of concurrent peritoneal lavage cytology and immunohistochemical examination that approximately doubles the detection of minimal peritoneal tumour spread has not been defined conclusively.…”

Section: Diagnostic Laparoscopymentioning

confidence: 99%