Is there a role for staging laparoscopy in patients with locally advanced, unresectable pancreatic adenocarcinoma? Journal Article
| Authors: | Shoup, M.; Winston, C.; Brennan, M. F.; Bassman, D.; Conlon, K. C. |
| Article Title: | Is there a role for staging laparoscopy in patients with locally advanced, unresectable pancreatic adenocarcinoma? |
| Abstract: | The study objective was to determine the incidence of laparoscopically detected metastasis in patients with radiographically staged locally advanced adenocarcinoma of the pancreas. Patients with locally advanced pancreatic cancer are considered candidates for novel treatment protocols. Stratification of patients into locally advanced disease versus metastatic disease is imperative to accurately evaluate treatment outcome. Between 1994 and 2000, 100 consecutive patients undergoing staging laparoscopy with radiologic evidence of unresectable locally advanced pancreatic cancer were identified from a prospective database. All patients had preoperative contrast-enhanced, thin-cut computed tomography scanning or magnetic resonance imaging and had no evidence of detectable metastatic disease. There were 53 men and 47 women, with a median age of 64 years. The disease site was the pancreatic head in 69 cases and the body or tail in 31. Radiographic assessment of nonresectability was due to encasement of the celiac or hepatic artery in 37 patients, of the portal vein and superior mesenteric vessels in 56, and extrapancreatic extension in 7. Laparoscopy identified metastatic disease in 37% of patients, not seen on preoperative imaging. Peritoneal disease was noted in 12 cases and liver metastasis in 18 cases, and 7 patients had both. Neither the primary tumor size nor location influenced the incidence of metastatic disease. Standard imaging modalities failed to detect metastatic disease in 37% of patients who were considered to have locally advanced pancreatic cancer. Patients considered for treatment protocols for locally unresectable pancreatic cancer should be staged laparoscopically before initiation of therapy. © 2004 The Society for Surgery of the Alimentary Tract. |
| Keywords: | adult; treatment outcome; aged; middle aged; cancer surgery; major clinical study; cancer localization; liver neoplasms; conference paper; pancreas cancer; pancreatic neoplasms; cancer staging; nuclear magnetic resonance imaging; magnetic resonance imaging; staging; cancer incidence; neoplasm staging; laparoscopy; prospective studies; adenocarcinoma; tumor localization; metastasis; computer assisted tomography; peritoneal neoplasms; tumor volume; incidence; tomography, x-ray computed; data base; imaging system; liver metastasis; preoperative period; neoplasm metastasis; pancreas adenocarcinoma; radiography; pancreatic cancer; databases, factual; time series analysis; portal vein; hepatic artery; peritoneal disease; celiac artery; superior mesenteric artery; superior mesenteric vein; humans; human; male; female |
| Journal Title: | Journal of Gastrointestinal Surgery |
| Volume: | 8 |
| Issue: | 8 |
| ISSN: | 1091-255X |
| Publisher: | Springer |
| Date Published: | 2004-12-01 |
| Start Page: | 1068 |
| End Page: | 1071 |
| Language: | English |
| DOI: | 10.1016/j.gassur.2004.09.026 |
| PROVIDER: | scopus |
| PUBMED: | 15585395 |
| DOI/URL: | |
| Notes: | Presented at the SSAT 43rd Annual Meeting; 2002 May 19-22; San Francisco, CA -- Cited By (since 1996):49 -- Export Date: 16 June 2014 -- Source: Scopus |
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