title: High serum CA 19-9 but not tumor size should select patients for staging laparoscopy in radiological resectable pancreas head and peri-ampullary cancer.
abstract: BACKGROUND
  The objective of this study was to validate current recommendations for the selective use of staging laparoscopy in patients with radiological resectable pancreas head and peri-ampullary tumors.
  
  
  METHODS
  Data from a prospectively collected database (2007-2013) of 136 patients with peri-pancreatic head cancer were analyzed.
  
  
  RESULTS
  Over a 6 year time period, 136 patients were evaluated, 126 patients were deemed radiological resectable and underwent laparotomy and 10 patients were characterized radiological unresectable. There were 111 patients with pancreas head resection and 15 without resection (8 due to extensive vascular involvement and 3 due to peritoneal/liver metastases). The sensitivity, specificity, PPV and NPV of pre-operative radiological imaging in determining unresectability due to liver/peritoneal metastases were 42%, 100%, 100% and 94.7% respectively. There was a significant difference in CA 19-9 values between metastatic and non-metastatic disease (p = 0.020). ROC curve analysis calculated the optimal CA 19-9 cutoff point for predicting metastasis at 215.37 U/ml with a sensitivity of 72.7%, a specificity of 58.3%, PPV of 15.1% and NPV of 95.5%. Tumor diameter was not a significant factor in predicting resectability. Laparoscopy would have been useful in only 5.3% of patients in the present series.
  
  
  CONCLUSIONS
  High CA 19-9 values (>215 U/ml) and not tumor size should select patients with radiological resectable peri-pancreatic cancer for staging laparoscopy.
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece. Electronic address: nalexak@med.uoa.gr.
authors.forename: N
authors.initials: N
authors.lastname: Alexakis
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece.
authors.forename: I P
authors.initials: IP
authors.lastname: Gomatos
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Sbarounis
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Toutouzas
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Katsaragakis
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Zografos
authors.affiliation: Department of Surgery, University of Athens, Hippocratio NHS Hospital, Athens, Greece.
authors.forename: M M
authors.initials: MM
authors.lastname: Konstandoulakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology; D019540:Area Under Curve; D018395:CA-19-9 Antigen / Q000097:blood*; D003949:Diagnostic Techniques, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D011237:Predictive Value of Tests; D012372:ROC Curve; D011859:Radiography; D047368:Tumor Burden
chemical_list: D018395:CA-19-9 Antigen
keywords: CA 19-9; Pancreas cancer; Peri-ampullary cancer staging laparoscopy