Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma.
BACKGROUND
Staging laparoscopy for patients with radiographically resectable pancreatic adenocarcinoma has been reported to yield an 8-15% finding of unresectable disease. Factors associated with the likelihood of subradiographic unresectable disease have not been clearly defined.


METHODS
A prospectively maintained pancreatic database was reviewed and patients were identified who underwent staging laparoscopy for radiographically resectable pancreatic adenocarcinoma between January 2000 and December 2006. Preoperative carbohydrate antigen 19-9 (CA 19-9) values were assessed for their association with the presence of subradiographic unresectable disease.


RESULTS
Four hundred ninety-one patients underwent staging laparoscopy. Resection was performed in 80% (n = 395). Of the 96 patients with unresectable disease, 75 (78%) had metastases either in the liver (n = 60) or peritoneum (n = 15). Preoperative CA 19-9 values were available for 262 of the 491 patients. Fifty-one of these patients had unresectable disease, of which 78% were due to distant disease. The median preoperative CA 19-9 value for patients who underwent resection was 131 U/ml versus 379 U/ml for those patients with unresectable disease (P = 0.003). A receiver operating characteristics (ROC) curve was developed for preoperative CA 19-9 value and tumor resectability. The statistically optimal cutoff value was determined to be 130 U/ml. Unresectable disease was identified in 38 of the 144 patients (26.4%) with a preoperative CA 19-9 >or= 130 U/ml, and in 13 of the 118 patients (11%) with a CA 19-9 < 130 U/ml (P = 0.003). CA 19-9 values greater than 130 U/ml remained a predictor of tumor unresectability on multivariate regression analysis [hazard ratio (HR) 2.70, 95% confidence interval (CI) 1.34-5.44; P = 0.005].


CONCLUSIONS
In this study, preoperative CA 19-9 values were strongly associated with the identification of subradiographic unresectable disease. Preoperative CA 19-9 values may allow surgeons to better select patients for staging laparoscopy.
Maithel
Shishir K
SK
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Maloney
Stephen
S
Winston
Corrine
C
Gönen
Mithat
M
D'Angelica
Michael I
MI
Dematteo
Ronald P
RP
Jarnagin
William R
WR
Brennan
Murray F
MF
Allen
Peter J
PJ
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000378:metabolism*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D012680:Sensitivity and Specificity
D018395:CA-19-9 Antigen