title: Selective use of staging laparoscopy based on carbohydrate antigen 19-9 level and tumor size in patients with radiographically defined potentially or borderline resectable pancreatic cancer.
abstract: OBJECTIVE
  The aims of this study were to verify whether the selective use of staging laparoscopy can prevent unnecessary laparotomy and to find a surrogate marker for surgical unresectability in patients with potentially or borderline resectable pancreatic cancer.
  
  
  METHODS
  Group A consisted of consecutive 33 patients evaluated between 2005 and 2006 and who directly underwent open laparotomy for planned surgical resection. Group B consisted of consecutive 61 patients evaluated between 2007 and 2009 and of whom 16 patients (26%) had a staging laparoscopy due to the presence of high-risk markers of unresectability defined as carbohydrate antigen 19-9 level 150 U/mL or greater and tumor size 30 mm or greater.
  
  
  RESULTS
  The frequency of unnecessary laparotomies for occult distant organ metastasis was significantly different between groups A and B (18% and 3%, respectively; P = 0.021). Of 16 patients who underwent staging laparoscopy in group B, 5 patients (31%) had occult metastases. The multivariate analysis showed that the presence of high-risk markers and extrapancreatic plexus invasion on multidetector-row computed tomography were significant independent risk factors for unresectability.
  
  
  CONCLUSIONS
  The presence of high-risk markers was associated with surgical unresectability in patients with potentially or borderline resectable pancreatic cancer. The selective use of staging laparoscopy decreased the frequency of unnecessary laparotomy by detecting minute metastases.
authors.affiliation: Department of Surgery, Kansai Medical University, Hirakata-City, Osaka, Japan. satoi@hirakata.kmu.ac.jp
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirooka
authors.forename: So
authors.initials: S
authors.lastname: Yamaki
authors.forename: Rintaro
authors.initials: R
authors.lastname: Yui
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen