Laparoscopic staging and subsequent palliation in patients with peripancreatic carcinoma

Laparoscopic staging and subsequent palliation in patients with peripancreatic carcinoma

To test the hypothesis that laparoscopic staging improves outcome in patients with peripancreatic carcinoma compared to standard radiology staging. Diagnostic laparoscopy of peripancreatic malignancies has been reported to improve assessment of tumor stage and to prevent unnecessary exploratory lapa...

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Bibliographic Details
Published in:Annals of surgery Vol. 237; no. 1; pp. 66 - 73
Main Authors: NIEVEEN VAN DIJKUM, Els J. M, ROMIJN, Mark G, GOUMA, Dirk J, TERWEE, Caroline B, DE WIT, Laurens Th, VAN DER MEULEN, Jan H. P, LAMERIS, Han S, RAUWS, Erik A. J, OBERTOP, Huug, VAN EYCK, Casper H. J, BOSSUYT, Patrick M. M
Format: Journal Article
Language:English
Published: Hagerstown, MD Lippincott 2003
Subjects:
Aged
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - pathology
Bile Duct Neoplasms - surgery
Biological and medical sciences
Cholangiopancreatography, Endoscopic Retrograde - methods
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Laparoscopy - methods
Laparotomy - methods
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Minimally Invasive Surgical Procedures - methods
Neoplasm Staging
Original
Palliative Care - methods
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Prospective Studies
Reference Values
Sensitivity and Specificity
Severity of Illness Index
Survival Analysis
Tomography, X-Ray Computed
Treatment Outcome
Tumors
Ultrasonography, Interventional
Human
Carcinoma
Prognosis
Stage classification
Laparoscopy
Malignant tumor
Survival
Improvement
Accuracy
Digestive diseases
Endoscopy
Diagnosis
Pancreas
Pancreatic disease
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Description
Summary:To test the hypothesis that laparoscopic staging improves outcome in patients with peripancreatic carcinoma compared to standard radiology staging. Diagnostic laparoscopy of peripancreatic malignancies has been reported to improve assessment of tumor stage and to prevent unnecessary exploratory laparotomies in 10% to 76% of patients. Laparoscopy and laparoscopic ultrasound were performed in 297 consecutive patients with peripancreatic carcinoma scheduled for surgery after radiologic staging. Patients with pathology-proven unresectable tumors were randomly allocated to either surgical or endoscopic palliation. All others underwent laparotomy. Laparoscopic staging detected biopsy-proven unresectable disease in 39 patients (13%). At laparotomy, unresectable disease was found in another 72 patients, leading to a detection rate for laparoscopic staging of 35%. In total, 145 of the 197 patients classified as having "possibly resectable" disease after laparoscopic staging underwent resection (74%). Average survival in the group of 14 patients with biopsy-proven unresectable tumors randomly allocated to endoscopic palliation was 116 days, with a mean hospital-free survival of 94 days. The corresponding figures were 192 days and 164 days in the 13 patients allocated to surgical palliation. Because of the limited detection rate for unresectable metastatic disease and the likely absence of a large gain after switching from surgical to endoscopic palliation, laparoscopic staging should not be performed routinely in patients with peripancreatic carcinoma.
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ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-200301000-00010