title: Is there still a role for laparoscopy combined with laparoscopic ultrasonography in the staging of pancreatic cancer?
abstract: 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.
authors.affiliation: 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
authors.forename: Matteo
authors.initials: M
authors.lastname: Barabino
authors.forename: Roberto
authors.initials: R
authors.lastname: Santambrogio
authors.forename: Andrea
authors.initials: A
authors.lastname: Pisani Ceretti
authors.forename: Rocco
authors.initials: R
authors.lastname: Scalzone
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Enrico
authors.initials: E
authors.lastname: Opocher
mesh_terms: 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*