Application Of Laparoscopy In The Diagnosis And Treatment For The Patients With Unknown Elevated CA19-9

Background and PurposeCarbohydrate antigen 19-9(CA19-9)was isolated by Koprowski using a monoclonal antibody generated against colonic carcinoma cell lines in 1979.It has been identified as a monosialo-ganglioside and associated with Lewis blood group phenotypes.CA19-9 can be secreted by the epithelium of gastric,intestine and pancreas.It is present in low levels in the blood of nomarly adult,high levels in patients with carcinoma of pancreas,biliary and colorectal,and occasionally high in hepatocellular,lung and ovarian cancer.The serum value is associated with the course of the tumor.CA199 is used in the diagnosis,evaluate efficiency and follow-up for gastrointestinal carcinoma as a tumor marker.Compared with the high sensitivity in diagnosis of carcinoma,CA19-9 has a low specificity and positive predictive value(PPV).Slightly elevate of CA19-9 levels are also found in benign diseases such as obstructive jaundice,chronic pancreatitis,acute cholangitis,liver cirrhosis,spleen cyst.Jiang JT reported a low PPV(68.2%)in diagnosis of pancreatic cancer.To these patients,who have elevated CA19-9 levels, but no evidence of tumor in image examination,it's hard to identify.Mostly we depend on following up the CA19-9,ultrasound,and enhance CT. Since Mouret first reported the laparoscopic chelecystectomy in 1987,laparoscope is widely used in surgery,which has the advantages of less surgical trauma,faster recovery and shorter hospital stay.We has been use laparoscope and laparoscopic ultrasonagraphy in diagnosis and staging pancreatic cancer with a satisfied result.This paper retrospectively analyze the clinical data of laparoscopic operation for patients with unknown elevated CA19-9,in order to assess the application of laparoscope in these patients.Mehods1.ObjectRetrospectively analyze the clinical data of 61 laparoscopic operation for patients with unknown elevated CA19-9 in Sir Run Run Shaw Hospital,from Jan 2006 to Oct 2007.All patients have elevated CA19-9 levels,but no evidence of tumor in image examination.2.Measures①General data:gender,age,pre-operation examination results(CA19-9,X-ray, ultrasound,enhance CT).②Operative data:type of procedure,operative time,blood loss,hospital stay, complication.③Pathological diagnosis:frozen section and paraffin section examination.④Follow-up:Detect the CA19-9 in 1st month,and follow up the CA199,X-ray, ultrasound,enhance CT at an interval of 2 to 3 month for the patients with elevated CA199 postoperation.3.StatisticAll the data were collected by SPSS statistical.We calculate the mean,and the outcome is presented with x±s,use independent t—test.Results1.Totally 61 patients with elevated CA19-9 underwent laparoscopic operation, including 31 men,30 women.The average age was55.97±16.48 years(range from 22 to 91).2.Type of procedure:There were 59 patients underwent laparoscopic procedure successfully,including laparoscopic cholecystectomy for 41 cases,laparoscopic cholecystectomy + common bile duct exploration for 7 cases,laparoscopic cholecystectomy +EST for 3 cases,laparoscopic cholecystectomy+ resection of ovarian cyst for 2 cases,Laparoscopic fenestration of hepatic cyst for 5cases, laparoscopic spleenectomy for 1 case.The other 2 cases were received laparoscopic cholecystectomy and conversed to open radical resection of gallbladder cancer,because the intraoperative frozen section hinted gallbladder adenocarcinoma.3.Operative data:The mean operative time was73.26±27.32min(range from 40 min to 140 min).The mean blood lossw as145.70±35.06 m l(range from 20 ml to 200ml).4.The mean hospital stay was 3.13±1.55d(range from 2d to 7d).No complication occurred in all patients.5.Pathological diagnosis:59 patients were benign disease,only 2 patients were malignant tumor(gallbladder carcinoma).6.Follow-up:In the 1st month,there were 51 patients whose CA19-9 levels returned to normal.In the 3rd month,there were another 9 patients whose CA19-9 levels returned to normal.Only for one patient,the serum value was still high(range from 40 to 60 U/ml),and within 10 months follow up,no evidence of tumor was found.There were 45 patients whose preoperative CA19-9 levels between 37U/mL and 200 U/mL,with the mean 71.03±32.96 U/mL,and the postoperative value was 20.39±11.35 U/mL(p＜0.01),respectively.There were 11 patients whose preoperative CA19-9 levels between 200 U/mL and 1 000U/mL,with the mean 337.51±138.90 U/mL,and the postoperative value was 43.11±33.79 U/mL(p＜0.01),respectively.There were 5 patients whose preoperative CA19-9 higher than 1 000U/mL, with the mean 337.51±138.90 U/mL,and the postoperative value was 43.11±33.79 U/mL(p＜0.05),respectively.ConclusionApplication of laparoscopic surgery in the patients with unknown elevated CA19-9,who suffer from benign disease with elevated serum CA19-9,but without the evidence of carcinoma,can identify the reason of elevated CA19-9,and may be helpful to early diagnosis and treatment for incidence neoplasm.