The value of laparoscopy in the management of ampullary, duodenal, and distal bile duct tumors Journal Article

Authors: Brooks, A. D.; Mallis, M. J. Jr; Brennan, M. F.; Conlon, K. C. P.
Article Title: The value of laparoscopy in the management of ampullary, duodenal, and distal bile duct tumors
Abstract: Laparoscopy identifies radiologically occult advanced disease in patients with pancreatic adenocarcinoma. The value of laparoscopy in the management of peri-ampullary tumors was determined. One hundred forty-four patients with radiologically resectable nonpancreatic adenocarcinoma, periampullary tumors were identified from a prospective database between August 1993 and December 2000. Criteria for laparoscopic unresectability included histologically proved peritoneal or hepatic metastases, distant nodal involvement, arterial involvement, and local extension outside the resection field. Median age at operation was 70 years (range 31 to 87 years) and 56% of the patients were men. An adequate laparoscopy was performed in 134 cases (93%). Laparoscopy identified 13 patients (10%) with unresectable disease. Of 121 patients with laparoscopic resectable disease, 111 (92%) went on to subsequent resection; CT correctly predicted resectability in 82%. Laparoscopy spared 36% of unresectable patients a nontherapeutic laparotomy. Patients with resectable disease were treated by pancreaticoduodenectomy (n = 91, 76%), ampullectomy (n = 12, 10%), duodenal resection (n = 10, 9%), or bile duct excision (n = 6, 5%). The addition of diagnostic laparoscopy to dynamic CT scanning in this selected patient population identifies an additional 10% of patients with unresectable disease. We believe that laparoscopy should be used in a selective manner for preoperative staging of patients suspected of having nonpancreatic periampullary tumors. © 2002 The Society for Surgery of the Alimentary Tract, Inc.
Keywords: adult; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; major clinical study; mortality; pancreatic neoplasms; cancer staging; methodology; staging; neoplasm staging; laparoscopy; preoperative evaluation; prospective study; sensitivity and specificity; prospective studies; pancreaticoduodenectomy; diagnostic procedure; computer assisted tomography; tomography, x-ray computed; pathology; histology; liver metastasis; register; registries; biopsy, needle; needle biopsy; pancreas tumor; biliary tract surgery; pancreatic cancer; abdominal surgery; peritoneum metastasis; intestine surgery; digestive system surgical procedures; vater papilla; bile duct tumor; ampulla of vater; common bile duct neoplasms; duodenum cancer; duodenal neoplasms; humans; prognosis; human; male; female; article; duodenum tumor; upper gi malignancy
Journal Title: Journal of Gastrointestinal Surgery
Volume: 6
Issue: 2
ISSN: 1091-255X
Publisher: Springer  
Date Published: 2002-04-01
Start Page: 139
End Page: 145
Language: English
DOI: 10.1016/s1091-255x(01)00021-x
PUBMED: 11992798
PROVIDER: scopus
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    782 Brennan
  2. Ari D Brooks
    25 Brooks
  3. Kevin C Conlon
    113 Conlon