The use of diagnostic laparoscopy supported by laparoscopic ultrasonography in the assessment of pancreatic cancer

• Published in: Surgical endoscopy Vol. 13; no. 3; pp. 239 - 245
• Main Authors: CATHELINE, J. M, TURNER, R, RIZK, N, BARRAT, C, CHAMPAULT, G
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.03.1999
• Subjects: Biological and medical sciences; Digestive system. Abdomen; Endosonography; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Liver Neoplasms - secondary; Male; Medical sciences; Middle Aged; Palliative Care; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Peritoneal Neoplasms - secondary; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonic investigative techniques; Sonography; Adenocarcinoma; Performance evaluation; Human; Exploration; Surgical resection; Laparoscopy; Malignant tumor; Optimization; Association; Surgery; Echography; Digestive diseases; Endoscopy; Diagnosis; Pancreas; Pancreatic disease
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s004649900954

Pancreatic resection with curative intent is possible in a select minority of patients with carcinomas of the pancreatic head. Diagnostic laparoscopy supported by laparoscopic ultrasonography combines the proven benefits of staging laparoscopy with high-resolution intraoperative ultrasound, thus allowing the surgeon to perform a detailed assessment of the pancreatic cancer. In a prospective study of 26 patients with obstructive jaundice from a carcinoma of the head of the pancreas, the curative resectability of tumors was assessed by ultrasound (26 cases), computerized tomography (26 cases), endoscopic ultrasound (16 cases), and a combination of diagnostic laparoscopy and laparoscopic ultrasound (26 cases). The findings of ultrasound and computerized tomography were comparable: 50% of patients were excluded from curative resection. Endoscopic ultrasound provided precise information on the primary tumors. The accuracy of the combined diagnostic laparoscopy and laparoscopic ultrasound, when compared with ultrasound, computerized tomography, and endoscopic ultrasound, was better with respect to minute peritoneal or hepatic metastasis: 80.7% (or a further 30.7%) of patients did not qualify for curative resection. Diagnostic laparoscopy supported by laparoscopic ultrasonography enables detection of previously unsuspected metastases; thus, needless laparotomy can be avoided. It should therefore be considered the first step in any potentially curative surgical procedure.