Combined endoscopic and laparoscopic ultrasound as preoperative assessment of patients with pancreatic cancer.
BACKGROUND
An accurate pre-therapeutic assessment of the resectability in pancreatic cancer patients is essential to reduce the number of futile surgical explorations. The aim of this study was to assess the combination of endoscopic ultrasound (EUS) and laparoscopic ultrasound (LUS) regarding the detection of patients with non-resectable tumours.


METHODS
From 2002 to 2004, 179 consecutive patients with pancreatic cancer referred for surgical treatment were eligible. Thirty-one (17%) patients were excluded due to co-morbidity and poor performance status. Two patients (1%) were excluded due to metastasis seen on CT scans prior to referral. Thus, 146 patients entered the study. Patients were first examined with EUS followed by LUS, if EUS found no signs of non-resectability. Only patients with tumours found to be resectable or possibly resectable at EUS and LUS were offered surgical treatment. Resectability criteria were defined prior to the study.


RESULTS
In all, 108 (74%) patients had non-resectable tumours by the pre-defined criteria. EUS identified 68 (63%) patients and LUS identified an additional 26 (24%) patients. Thus, a total of 94 (87%) patients were non-resectable at either EUS or LUS. Fifty-two (36%) patients underwent surgery. Six patients had surgical exploration and three patients had palliative surgery. Forty-three patients (29%) were resected with curative intention, of whom 38 (88%) had an R0 resection and 5 (12%) had a palliative resection.


CONCLUSIONS
The combination of EUS and LUS is accurate in identifying the non-resectable patients and has a high predictive value for complete resection.
Fristrup
C W
CW
Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark. claus@fristrup.net
Mortensen
M B
MB
Pless
T
T
Durup
J
J
Ainsworth
A
A
Hovendal
C
C
Nielsen
H O
HO