[Preoperative staging of pancreatic adenocarcinoma: a practice survey of French gastroenterologists and digestive surgeons. Ordering of supplemental examinations and preoperative criteria of loco-regional spread].
BACKGROUND
Means used by physicians to perform preoperative staging of pancreatic adenocarcinoma are not well known. Therapeutic strategy used relies on knowledge of loco-regional spread criteria.


OBJECTIVE
To assess the frequency of prescription of imaging procedures in patients with suspected pancreatic head adenocarcinoma; the use by French gastroenterologists (GE) and digestive surgeons (S) of criteria which lead to suspect lymph node invasion or vascular involvement; the frequency of histological determination in patients with unresectable tumor; if there is a difference between GE and S.


METHODS
All the French GE (n = 3466) and S (n = 687) were sent a survey asking them about their habits.


RESULTS
615 answers were received (GE = 426, S = 189). There was no significant difference between GE and S for the prescription of ultrasonography and CT scan. Endosonography and upper digestive endoscopy were more systematically performed by GE than S (44 vs 35% and 50 vs 35%, respectively). Celio-mesenteric angiography was less often used by GE (6 vs 13%). Laparoscopy was electively used by 35% GE and 52% S. None of vascular involvement criteria was used by more than 75% of GE and S. Tumor-vessel interface loss was used by 46% GE and 16% S (P < 0.001). Intravascular thrombosis and truncular portal hypertension signs were used more often by S than GE (84 vs. 71%: P < 0.001; 65 vs. 51%: P < 0.001). None of nodal involvement criteria was used by more than 50% of physicians. All these nodal criteria were used more often by GE than S (P < 0.001). Percentage of physicians requiring histological confirmation in case of unresectable tumor was 41%.


CONCLUSIONS
Preoperative staging of suspected pancreatic head adenocarcinoma is performed with grossly the same manner by GE and S. Histological proof is searched for in a low percentage of cases. Imaging criteria of loco-regional spread of pancreatic adenocarcinoma are heterogeneously used by GE and S, the former using them more frequently than the latter. A better use of imaging criteria is necessary to optimise the treatment of patients with pancreatic adenocarcinoma.
Lévy
P
P
Département Médico-Chirurgical de Pathologie Digestive, IMM, Paris.
Boudet
M J
MJ
Zins
M
M
Gayet
B
B
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000792:Angiography; D001706:Biopsy; D003627:Data Interpretation, Statistical; D019160:Endosonography; D005762:Gastroenterology; D013502:General Surgery; D006801:Humans; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
Bilan préopératoire de l'adénocarcinome pancréatique: attitude pratique des gastroentérologues et des chirurgiens digestifs français. Prescription des examens complémentaires et critères préopératoires d'envahissement loco-régional.