TECHNICAL NOTES   

Chirurgia 1999 October;12(5):379-88

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Staging of pancreatic cancer by laparoscopy and laparoscopic ultrasonography

Occelli G., Feroce A., Barrat C., Catheline J. M., Champault G.

Background.This prospective study was undertataken to evaluate the efficiency of staging laparoscopy associated with laparoscopic ultrasonogrqaphy to decide surgical resectability in pancreatic carcinoma.
Methods. From June 1995 to March 1997, 26 patients were examined. Four staging method were used: Percutaneous ultrasonography, Computed Tomography, endoscopic ultrasonography ( n=16 ) and explorative laparoscopy with laparoscopic ultrasonography. The assessment of resecability was verified by surgical exploration and histologic examination.
Results. Results of percutaneous ultrasonography and Computed Tomography were similar, predicting unresectability in 50% of patients. Endoscopic ultrasonography performed in 16 patients without visible metastases according to the previous procedures predicted surgical resecability in seven patients only. With staging laparoscopy associated with laparoscopic ultrasonography, undiscovered metastases were found and unresecability was predicted in 21 patients out of 26; the sensivity was 100% for liver metastates, peritoneal metastates and vascular involvement, 90% for lymph node involvement and 88% for diagnosis of the primitive lesion. An unnecessary laparotomy was avoided in 12 patients.
Conclusions. Staging laparoscopy associated with laparoscopic ultrasonography is superior to all other staging methods. It should be the first step of potentially curative surgical treatment (five cases) or of a palliative bypass. Laparotomy was avoided in 12 cases.