Laparoscopy and Laparoscopic Ultrasound for Diagnosis and Staging
Potentially curative resection of pancreatic cancer is dependent on prompt, accurate diagnosis and staging, patient fitness and expert surgery, which if supplemented by adjuvant chemotherapy can increase 5-year survival to 30%. Diagnosis and staging are u
- PDF / 154,039 Bytes
- 12 Pages / 439.37 x 666.142 pts Page_size
- 116 Downloads / 206 Views
J. P. Neoptolemos, R. Urrutia, J. L. Abbruzzese, M. W. Bu¨chler (eds.), Pancreatic Cancer, DOI 10.1007/978-0-387-77498-5_32, # Springer Science+Business Media, LLC 2010
802
32
Laparoscopy and Laparoscopic Ultrasound for Diagnosis and Staging
Abstract: Potentially curative resection of pancreatic cancer is dependent on prompt, accurate diagnosis and staging, patient fitness and expert surgery, which if supplemented by adjuvant chemotherapy can increase 5-year survival to 30%. Diagnosis and staging are undertaken using contrast enhanced, multi-detector computerized tomography (CE-MDCT) or magnetic resonance imaging (MRI), supplemented with endoscopic ultrasound and/or laparoscopy with or without laparoscopic ultrasound (L/LUS). L/LUS has been found to detect advanced and/or metastatic disease in 13–28% of patients with pancreatic cancer considered potentially resectable on CE-MDCT/MRI, but between 1 and 30% of patients thought to be resectable on L/LUS have subsequently been found to have unresectable disease at laparotomy. To increase the clinical utility of L/LUS, a selective approach has been adopted by a number of groups, only undertaking L/LUS when one or more criteria are present, including: (1) presumed pancreatic primary >3 cm diameter, (2) CA 19-9 > 150 kU/L (>300 when total bilirubin >35 micromol/L), (3) platelet/lymphocyte ratio >150. The addition of peritoneal irrigation and cytology has been shown to further increase the detection of advanced disease unsuitable for resection. Further work is required to increase the accuracy of L/LUS, especially to identify unresectable disease when CE-MDCT/MRI suggests resectability or is equivocal. The importance of diagnosis and staging in the management of pancreas cancer becomes evident when surveying the outcome of patients with localized versus advanced disease. Laparoscopy with or without laparoscopic ultrasound (L/LUS) are among those investigative tools which permit more accurate diagnosis and staging prior to the choice of treatment, that in a minority of patients should include major resectional surgery. Pancreas cancer is the fourth cause of all cancer deaths (6%) in the Western world in both men and women [1]. The overall 5 year survival is 2 cm in length, >50% circumferential involvement)
803
804
32
Laparoscopy and Laparoscopic Ultrasound for Diagnosis and Staging
CE-MDCT, local tumor extension, vascular involvement, lymph node and liver metastases correlate closely with surgical findings [8]. Initial results of positron emission tomography (PET-CT) in staging pancreatic cancer patients show that it may detect metastatic disease with greater accuracy that CT alone (sensitivity 87% and accuracy 94% [10,11]) and has been reported to change management in 11% of otherwise potentially resectable patients [11]. PET-CT has been found to have the same sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in evaluating primary tumors as CE-MDCT [10,11] or EUS [12], indicating that PET-CT does not add to the determi
Data Loading...
