Laparoscopy and Laparoscopic Ultrasonography for Staging Pancreatic Cancer: Critical Appraisal

Abstract.

A pilot study was designed to elucidate the role of staging laparoscopy for determining resectability in patients with pancreatic cancer. The additional value of laparoscopic contact ultrasonography (LCU) was also evaluated with specific regard to its ability to detect hepatic metastases and assess vascular infiltration of the portomesenteric trunk. A consecutive sample of 50 patients referred for operation of a suspected pancreatic cancer were submitted to preoperative contrast-enhanced high-resolution computed tomography (CT) and staging laparoscopy combined with LCU at a university hospital. For those progressing to exploratory laparotomy, the intraoperative findings relating to tumor diffusion and vascular infiltration were compared to CT, laparoscopic, and LCU data. Analytical description of the laparoscopic findings is given. Row data of predicted versus observed vascular infiltration were tabulated for CT and LCU. The sensitivity, specificity, and overall accuracy of each diagnostic test were calculated for comparative analysis. Laparoscopy alone prevented unnecessary laparotomy in 20% of cases. A complete procedure could not be achieved in 28% of patients. Three false-negative staging results occurred. LCU identified small (benign) hepatic nodules not seen by CT in 8% of patients. Sensitivity, specificity, and overall accuracy for assessing vascular infiltration were 82%, 53%, and 69% for CT and 94%, 80%, and 87% for LCU. Laparoscopy was confirmed to be safe and effective for staging pancreatic cancer. Because of its unique capabilities to detect even small peritoneal tumor deposits a quick exploration immediately before laparotomy is advised in all patients. The additional benefit of a more extensive procedure is not supported by our results. Although LCU appears to define the vascular involvement more accurately than conventional CT, the limitation of getting clinically useful ultrasound data in all the patients suggests its adoption in only a selected population.