Is there still a role for laparoscopy combined with laparoscopic ultrasonography in the staging of pancreatic cancer?
OBJECTIVE
This study was designed to compare our laparoscopic ultrasonography (LUS) experience in the resectability evaluation of pancreatic or periampullary cancers (PAC) in two different periods: before and after the introduction of multidetector CT (MDCT).


METHODS
We prospectively enrolled 104 CT-resectable patients with PAC. During Step 1 (1995-1999), we performed LUS on all patients, whereas during Step 2 (2002-2007), LUS was performed selectively according to Pisters' criteria.


RESULTS
LUS was satisfactorily performed in all cases. At Step 1 accuracy of LUS in predicting pancreatic resectability was high (96%) but it was markedly lower in a subgroup of patients with close contact between tumor and portal vein (sensibility of 57%). At Step 2, selective LUS was performed on 9 of 64 patients (14%). LUS confirmed the MDCT finding of unresectability in 8 of 9 cases, and allowed curative resection in 1 case. Only 1 of 55 of the patients who did not undergo LUS would have benefited from the procedure. The yield of LUS decreased from 45% before to 1.8% after MDCT.


CONCLUSIONS
In resectable-MDCT patients, routine LUS is unjustified. However, in doubtful MDCT cases, LUS has yet a good yield. In the event of close vascular contact, neither MDCT nor LUS seem to be conclusive, and laparotomy is still the only solution.
Barabino
Matteo
M
2rd Department of General Surgery, Faculty of Medicine, University of Milan, San Paolo Hospital, Via di Rudinì 8, 20142, Milan, Italy. matteo.barabino@alice.it
Santambrogio
Roberto
R
Pisani Ceretti
Andrea
A
Scalzone
Rocco
R
Montorsi
Marco
M
Opocher
Enrico
E
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008113:Liver Neoplasms / Q000556:secondary; D009367:Neoplasm Staging / Q000379:methods*; D010166:Palliative Care; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D018084:Ultrasonography, Interventional / Q000379:methods*