Value Of Laparoscopic Ultrasonography In The Diagnosis And Staging Of Pancreatic Cancer

Background and ObjectiveThe incidence of pancreatic cancer has been increasing in recent years. Because of concealing development and higher malignancy, it's resectability is very low and the prognosis is very poor. At present, the 5-year survival rates of pancreatic cancer is lower of 5%. The median survival time is lower of 20 months. Among them ,the local advanced is lower of 10 months and with distant metastasis is lower of 6 months. Complete surgical resection with negative margins offers the only chance for long-term survival. Then early diagnosis and accurate staging has become a 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.Recently the rapid development of increasingly sophisticated diagnostic imaging modalities has enhanced the accuracy of locating, qualifying and stagingof pancreatic cancer. The physicions' experiencing diagnosis thought model have progressively been changed. But the true extent of disease in pancreatic cancer remains difficult to fully ascertain nonoperatively. Recently someone had suggested that in combination with CT or MRJ patients with localized, potentially resectable pancreatic cancer should undergo a laparoscopic procedure prior to open exploration. The aim would be to detect subradiological disease and prevent unnecessary exploration. Recently along with the standardization of minimally invasive technique on tumor staging prior to open exploration, sophisticated and overall laparoscopic ascertainment have become possible . Laparoscopy, with the addition of laparoscopic ultrasonography, 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.For the sake of evaluate the value of laparoscopic and laparoscopic ultrasonography exploration 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, and all of the patients met laparoscopic ascertainment prior to open exploration.Methods and MaterialsPrior to laparotomy, Laparoscopic ascertainment were performed in 42 patients who were suspected of pancreatic cancer by Ultrasonography and CT scan . Laparoscopic Ultrasonography were performed in recent 23 patients.ResultsWith laparoscopic ascertainment(LA), 1 patient was diagnosed as primary peritonitis;11 patients with suspected abnormality in pancreas, 10 of them added with Laparoscopic ultrasonography, showed that 4 patients had pancreatic cyst, 2 patients had cystoadenoma and the others were normal;Of 30 patients with pancreatic cancer, 9 patients were found to have distal metastasis and of the other 21 patients, 8 patients underwent laparostomy directly, 2 of which with superior mesenteric vein encased was judged to be unresectable, 13 patients received Laparoscopic ultrasonography, 1 of which with superior mesenteric artery and vein encased was also judged to be unresectable, and 18 patients eventually received surgical resection. The sensitivity of LA in determining unresectability was 75%, The specificity is 100%. The positive predictive value was 100% and the negative predictive value was 85.7%. ConclusionLaparoscopy combined with Laparoscopic ultrasonography could improve the accuracy of the diagnosis and staging in pancreatic cancer, and has special value to avoide unnecessary laparotomy for some unresectable patients.