Application Of Laparoscopy And Laparoscopic Ultrasonography In The Diagnosis And Staging Of Pancreatic Cancer

The incidence of pancreatic cancer has been increasing in recent years. It's resectability is very low and the prognosis is very poor. In the United States, it has become the fourth leading cause of cancer-related deaths. In spite of improvement in diagnosis, only 10% to 15% of the patients present with resectable tumors, with 5-year survival rates of 15% to 20% reported following potentially "curative" resection. Complete surgical resection with negative margins offers the only chance for long-term survival. Then early diagnosis and accurate staging has become an key work to surgeons. And the goals of clinical staging should be directed not only at defining the extent of disease and directing appropriate therapy, but also at avoiding unnecessary intervention, in a safe and cost-effective manner.Notwithstanding the rapid development of increasingly sophisticated diagnostic imaging modalities, the true extent of disease in pancreatic cancer remains difficult to fully ascertain nonoperatively. Recently someone had suggested that in combination with CT or MRI patients with localized, potentially resectable pancreatic cancer should undergo a laparoscopic procedure prior to open exploration. The aim would beto detect subradiological disease and prevent unnecessary exploration. Recent improvements in the instrumentation coupled with the development of a multidisciplinary approach to palliation have rekindled interest in the modality. Laparoscopy, with the addition of laparoscopic ultrasound, allows the surgeon to visualize the primary tumors, accurately determine vascular involvement, identify regional nodal metastases, and detect small-volume peritoneal/liver metastases, all of which can be biopsied if required.In order to assess the value of laparoscopic exploration and laparoscopic ultrasonography in the diagnosis and staging of pancreatic cancer, we underwent a clinic study on the patients with localized, potentially resectable pancreatic tumor by Ultrasonography or CT, undergo laparoscopic exploration prior to open exploration.Methods and MaterialsBefore laparotomy, Laparoscopic exploration were performed in 30 patients who were suspected of pancreatic cancer by Ultrasonography and CT scan. Laparoscopic Ultrasonography were performed in recent 17 patients.ResultsBy laparoscopic exploration alone, 1 patient who was diagnosed as primary peritonitis; 8 patients with suspected abnormality in pancreas received Laparoscopic ultrasonography, which showed that 3 patients had pancreatic cyst, 2 patients had cystoadenoma and the others were normal; of 21 patients with pancreatic cancer, 6 patients were found to have distal metastasis and of the other 15 patients, 6 patients underwent laparostomy directly, 1 of which with superior mesenteric vein encased was judged to be unresectable, 9 patients received Laparoscopic ultrasonography, 1 of which with superior mesenteric artery and vein encased was also judged to be unresectable, and 13 patients eventually received surgical resection. The sensitivity of laparoscopic exploration in determining unresectability was 75%, The specificity is 100%. The positive predictive value was 100% and the negative predictive value was 86.7%.ConclusionLaparoscopy and Laparoscopic ultrasonography could improve the accuracy of the diagnosis and staging in pancreatic cancer, and could help avoide unnecessary laparotomy for some unresectable patients.