Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma Journal Article
| Authors: | Maithel, S. K.; Maloney, S.; Winston, C.; Gonen, M.; D'Angelica, M. I.; DeMatteo, R. P.; Jarnagin, W. R.; Brennan, M. F.; Allen, P. J. |
| Article Title: | Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma |
| Abstract: | Background: Staging laparoscopy for patients with radiographically resectable pancreatic adenocarcinoma has been reported to yield an 8-15% finding of unresectable disease. Factors associated with the likelihood of subradiographic unresectable disease have not been clearly defined. Methods: A prospectively maintained pancreatic database was reviewed and patients were identified who underwent staging laparoscopy for radiographically resectable pancreatic adenocarcinoma between January 2000 and December 2006. Preoperative carbohydrate antigen 19-9 (CA 19-9) values were assessed for their association with the presence of subradiographic unresectable disease. Results: Four hundred ninety-one patients underwent staging laparoscopy. Resection was performed in 80% (n = 395). Of the 96 patients with unresectable disease, 75 (78%) had metastases either in the liver (n = 60) or peritoneum (n = 15). Preoperative CA 19-9 values were available for 262 of the 491 patients. Fifty-one of these patients had unresectable disease, of which 78% were due to distant disease. The median preoperative CA 19-9 value for patients who underwent resection was 131 U/ml versus 379 U/ml for those patients with unresectable disease (P = 0.003). A receiver operating characteristics (ROC) curve was developed for preoperative CA 19-9 value and tumor resectability. The statistically optimal cutoff value was determined to be 130 U/ml. Unresectable disease was identified in 38 of the 144 patients (26.4%) with a preoperative CA 19-9 ≥ 130 U/ml, and in 13 of the 118 patients (11%) with a CA 19-9 < 130 U/ml (P = 0.003). CA 19-9 values greater than 130 U/ml remained a predictor of tumor unresectability on multivariate regression analysis [hazard ratio (HR) 2.70, 95% confidence interval (CI) 1.34-5.44; P = 0.005]. Conclusion: In this study, preoperative CA 19-9 values were strongly associated with the identification of subradiographic unresectable disease. Preoperative CA 19-9 values may allow surgeons to better select patients for staging laparoscopy. © 2008 Society of Surgical Oncology. |
| Keywords: | adult; aged; aged, 80 and over; middle aged; cancer surgery; major clinical study; patient selection; liver neoplasms; preoperative care; pancreatic neoplasms; cancer staging; neoplasm staging; laparoscopy; preoperative evaluation; sensitivity and specificity; prospective studies; adenocarcinoma; peritoneal neoplasms; ca 19-9 antigen; liver metastasis; predictive value of tests; pancreas adenocarcinoma; peritoneum metastasis; roc curve; ca-19-9 antigen; pancreatography |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 15 |
| Issue: | 12 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2008-12-01 |
| Start Page: | 3512 |
| End Page: | 3520 |
| Language: | English |
| DOI: | 10.1245/s10434-008-0134-5 |
| PUBMED: | 18781364 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 19" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus" |
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