Patients with pancreatic adenocarcinoma benefit from staging laparoscopy

Syed I. Ahmed, Victor Bochkarev, Dmitry Oleynikov, Aaron R. Sasson

Research output: Contribution to journalReview article

33 Citations (Scopus)

Abstract

Background: Unnecessary laparotomy in patients with advanced pancreatic cancer may both compromise the quality of life and delay the initiation of more appropriate therapy. Very often, peritoneal small liver metastases and true local status cannot be fully determined without surgery. Laparoscopy may spare laparotomy and decrease morbidity for patients with nonresectable advanced disease. The aim of this study was to determine the impact of laparoscopy in patients with potentially resectable adenocarcinonia of the pancreas. Materials and Methods: We reviewed the records of patients undergoing pancreatic surgery at the University of Nebraska Medical Center from October 2001 to April 2005. A total of 59 patients were included in the study. All patients were staged radiographically with a high resolution helical computed tomography scan and their tumors were considered resectable. Thirty-seven patients underwent staging laparoscopy while 22 proceeded directly to laparotomy. Results: Of the 37 patients who underwent laparoscopic staging, 9 (24.3%) were detected to have metastatic disease or advanced tumor; the remaining 28 (75.7%) patients with negative laparoscopy proceeded to laparotomy. Of those, 24 patients (85.7%) underwent pancreatic resection with curative intent, while 4 patients had metastatic or locally advanced disease at subsequent laparotomy which was missed on staging laparoscopy (false negative rate of 14.3%). Of the 22 patients who proceeded directly to laparotomy, 16 (72.7%) received curative Whipple resection and 6 (27.3%) were found to have advanced disease and received bypass procedures or biopsy alone. Conclusion: These findings suggest that staging laparoscopy is beneficial in a significant proportion of patients deemed resectable by routine noninvasive preoperative studies. We plan to add intraoperative laparoscopic ultrasound to our staging protocol in order to decrease the false negative rate.

Original languageEnglish (US)
Pages (from-to)458-463
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume16
Issue number5
DOIs
StatePublished - Oct 1 2006

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Laparoscopy
Adenocarcinoma
Laparotomy
Spiral Computed Tomography
Pancreatic Neoplasms
Pancreas
Neoplasms
Quality of Life
Neoplasm Metastasis
Morbidity
Biopsy

ASJC Scopus subject areas

  • Surgery

Cite this

Patients with pancreatic adenocarcinoma benefit from staging laparoscopy. / Ahmed, Syed I.; Bochkarev, Victor; Oleynikov, Dmitry; Sasson, Aaron R.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 16, No. 5, 01.10.2006, p. 458-463.

Research output: Contribution to journalReview article

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abstract = "Background: Unnecessary laparotomy in patients with advanced pancreatic cancer may both compromise the quality of life and delay the initiation of more appropriate therapy. Very often, peritoneal small liver metastases and true local status cannot be fully determined without surgery. Laparoscopy may spare laparotomy and decrease morbidity for patients with nonresectable advanced disease. The aim of this study was to determine the impact of laparoscopy in patients with potentially resectable adenocarcinonia of the pancreas. Materials and Methods: We reviewed the records of patients undergoing pancreatic surgery at the University of Nebraska Medical Center from October 2001 to April 2005. A total of 59 patients were included in the study. All patients were staged radiographically with a high resolution helical computed tomography scan and their tumors were considered resectable. Thirty-seven patients underwent staging laparoscopy while 22 proceeded directly to laparotomy. Results: Of the 37 patients who underwent laparoscopic staging, 9 (24.3{\%}) were detected to have metastatic disease or advanced tumor; the remaining 28 (75.7{\%}) patients with negative laparoscopy proceeded to laparotomy. Of those, 24 patients (85.7{\%}) underwent pancreatic resection with curative intent, while 4 patients had metastatic or locally advanced disease at subsequent laparotomy which was missed on staging laparoscopy (false negative rate of 14.3{\%}). Of the 22 patients who proceeded directly to laparotomy, 16 (72.7{\%}) received curative Whipple resection and 6 (27.3{\%}) were found to have advanced disease and received bypass procedures or biopsy alone. Conclusion: These findings suggest that staging laparoscopy is beneficial in a significant proportion of patients deemed resectable by routine noninvasive preoperative studies. We plan to add intraoperative laparoscopic ultrasound to our staging protocol in order to decrease the false negative rate.",
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