Abstract
Neoadjuvant chemoradiation therapy is used at many institutions for treatment of localized adenocarcinoma of the pancreas. Accurate staging before neoadjuvant therapy identifies patients with distant metastatic disease, and restaging after neoadjuvant therapy selects patients for laparotomy and attempted resection. The aims of this study were to (1) determine theutilityof staging laparoscopy in candidates for neoadjuvant therapy and (2) evaluate the accuracy of restaging CT following chemoradiation. Staging laparoscopy was performed in 98 patients with radiographically potentially resectable (no evidence of arterial abutment or venous occlusion) or locally advanced (arterial abutment or venous occlusion) adenocarcinoma of the pancreas. Unsuspected distant metastasis was identified in 8 (18%) of 45 patients with potentially resectable tumors and 13 (24%) of 55 patients with locally advanced tumors by CT Neoadjuvant chemoradiation therapy and restaging CT were completed in a total of 103 patients. Thirty-three patients with potentially resectable tumors by restaging CT underwent surgical exploration and resections were performed in 27 (82%). Eleven (22%) of 49 patients with locally advanced tumors by restaging CT were resected, with negative margins in 55%; the tumors in these 11 patients had been considered locally advanced because of arterial involvement on restaging CT Staging laparoscopy is useful for the exclusion of patients with unsuspected metastatic disease from aggressive neoadjuvant chemoradiation protocols. Following neoadjuvant chemoradiation, restaging CT guides the selection of patients for laparotomy but may overestimate unresectability to a greater extent than does prechemoradiation CT.
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Greenlee RT, Hill-Harmin MB, Murray T, Thun M. Cancer Statistics, 2001. CA Cancer J Clin 2001;51:15–36.
John T, Greig J, Carter D, Garden O. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 1995;221:156–164.
Fernandez-del Castillo C, Ratmer D, Warshaw A. Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg 1995;82:1127–1129.
Conlon K, Dougherty E, Khmstra D, et al.. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg 1996;223:134–140.
Holzman M, Reintgen K, Tyler D, Pappas T. The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies. J GASTROINTEST SURG 1997;1:236–244.
Warshaw A, Gu Z, Wittenberg J, Waltman A. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990;125:230–233.
Gulliver D, Baker M, Cheng C, et al.. Malignant biliary obstruction: Efficacy of thin-section dynamic CT in determining resectability. Am J Roentgenol 1992;159:503–507.
Freeny P, Traverso L, Ryan J. Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 1993;165:600–606.
Fuhrman G, Charnsangavej C, Abbruzzese J, et al.. Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 1994;167:104–113.
Willet C, Lewandrowski K, Warshaw A, et al.. Resection margins in carcinoma of the head of the pancreas: Implications for radiation therapy. Ann Surg 1993;217:144–148.
Jessup JM, Steele G Jr, Mayer RJ, et al.. Neoadjuvant therapy for unresectable pancreatic adenocarcinoma. Arch Surg 1993;128:559–564.
Spitz FR, Abbruzzese JL, Lee JE, et al.. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas [see comments]. J Clin Oncol 1997;15:928–937.
Hoffman JP, Lipsitz S, Pisansky T, et al.. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: An Eastern Cooperative Oncology Group Study. J Clin Oncol 1998:16:317–323.
White R, Lee C, AnscherM, et al.. Preoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas. Ann Surg Oncol 1999;6:38–45.
Jiminez RE, Warshaw AL, Rattner DW, et al.. Impact of laparoscopic staging in the treatment of pancreatic cancer. Arch Surg 2000;135:409–415.
Makary MA, Warshaw AL, Centeno BA, et al.. Implications of peritoneal cytology for pancreatic cancer management. Arch Surg 1998;133:361–365.
White R, Hurwitz H, Lee C, et al. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol (in press).
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White, R.R., Paulson, E.K., Freed, K.S. et al. Staging of pancreatic cancer before and after neoadjuvant chemoradiation. J Gastrointest Surg 5, 626–633 (2001). https://doi.org/10.1016/S1091-255X(01)80105-0
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DOI: https://doi.org/10.1016/S1091-255X(01)80105-0