The role of laparoscopy in the preoperative staging of pancreatic carcinoma

Rumstadt, B.; Schwab, Michael; Schuster, K. L.; Hagmüller, E.; Trede, M.

doi:10.1016/s1091-255x(97)80116-3

Cited by 68 publications

(45 citation statements)

References 22 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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“…We are convinced that the preoperative differentiation between benign and malignant lymph nodes in populations like ours cannot accurately be done without cytology or histology, and puncture under EUS guidance is possibly the most promising tool [37, 38, 39]. The roles of preoperative laparoscopy and laparoscopic ultrasonography are still discussed controversially, but their major diagnostic impact seems to be prediction of tumor unresectability and detection of liver metastases or peritoneal carcinomatosis, whereas the accuracy in lymph node staging is also disappointing [40, 41, 42]. …”

Section: Discussionmentioning

confidence: 99%

Prospective Comparison of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Preoperative Assessment of Masses in the Pancreatic Head

Glasbrenner¹,

Schwarz

Pauls

et al. 2000

Dig Surg

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Aims: To compare the diagnostic value of endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the differentiation of malignant from benign masses in the pancreatic head. Methods: Within 14 months 95 prospective patients with masses in the pancreatic head were assigned for preoperative EUS and ERCP. Both procedures were performed and recorded according to a standardized protocol. Based on intraoperative findings and histology, 50 patients (53%) suffered from malignant and 45 patients (47%) from benign (inflammatory) tumors. Results: Success rates were 96% for EUS and 95% for ERCP. The overall results for EUS and ERCP to predict malignant masses were, respectively: sensitivity 78 and 81%, specificity 93 and 88%, positive predictive value 93 and 89%, negative predictive value 78 and 80%, and diagnostic accuracy 85 and 84%. When EUS and ERCP were taken together, the sensitivity was 92% (specificity 85%), but the diagnostic accuracy (89%) was not significantly enhanced. The results for EUS to diagnose lymph node metastases preoperatively were: sensitivity 55%, specificity 91%, positive predictive value 69%, negative predictive value 84%, and accuracy 81%. Conclusions: EUS and ERCP have similar diagnostic accuracies to separate malignant from benign masses in the pancreatic head. Combination of both procedures is not superior to the use of one modality alone. Abnormal lymph nodes visualized on EUS in patients with inflammatory masses in the pancreatic head due to chronic pancreatitis should be interpreted cautiously.

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“…Furthermore, the introduction of laparoscopic ultrasound has been advanced as an additional benefit to detect intraparenchymal pancreatic lesions, malignant lymph nodes, and vascular invasion of the tumor [13, 14]. However, laparoscopy is an invasive procedure and its accuracy in predicting resectability of the tumor can be questioned, considering the problem of evaluating retroperitoneal tumor invasion [15]. In addition, laparoscopy followed by a laparotomy is cost- and time-intensive and non-invasive techniques such as CT or MRI have steadily improved [5]during the last 5 years.…”

Section: Introductionmentioning

confidence: 99%

Staging Laparoscopy and Its Indications in Pancreatic Cancer Patients

Hennig¹,

Tempia-Caliera²,

Hartel³

et al. 2002

Dig Surg

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Background: Laparoscopy has become a popular and widespread surgical technique. An important goal in the treatment of patients with pancreatic cancer is to avoid any unnecessary procedure. Laparoscopy has been suggested as a routine tool for staging in order to prevent unnecessary laparotomies in these patients. Methods: In this article we present our experience regarding the value of laparoscopic staging and review the literature on this topic. Results and Conclusion: A direct and conclusive comparison of the controversial literature is difficult because of different study designs. Inconsistent use of high-quality CT scans significantly affects the results. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a state-of-the-art CT scan has been performed previously. Therefore, we conclude that routine diagnostic laparoscopy is not justified in all patients with pancreatic cancer. Rather, selective use is appropriate, especially in patients in whom ascites is an indirect sign of peritoneal metastases, or if liver metastases cannot be surely excluded preoperatively. This approach is cost-effective and limits diagnostic laparoscopy to a subgroup of patients in whom a laparotomy can be avoided.

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The role of laparoscopy in the preoperative staging of pancreatic carcinoma

Cited by 68 publications

References 22 publications

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

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

Prospective Comparison of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Preoperative Assessment of Masses in the Pancreatic Head

Staging Laparoscopy and Its Indications in Pancreatic Cancer Patients

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