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2009, Number 1

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Rev Mex Cir Endoscop 2009; 10 (1)

Laparoscopy in the assessment of patients with pancreatic cancer

Lucena JR, Useche IC

Language: Spanish
References: 31
Page: 115-125
PDF size: 91.32 Kb.


ABSTRACT

Background: In recent years have brought important developments in preoperative imaging and use of laparoscopic staging for patients with pancreatic adenocarcinoma. Study design. We conducted a review of all patients with surgical managed pancreatic adenocarcinoma, using data from cancer registry of our institution, augmented with clinical information from primary medical record review. We documented the use of all staging modalities, including TAC, endoscopic ultrasonography and laparoscopy. Primary outcomes included resection with curative intent. The association between staging modalities, clinical features, and resection was measured using a multivariate logistic regression model. Results: There were 68 patients who met the eligibility criteria. Patients were staged using a combination of TAC (98%), laparoscopy (29%), and endoscopic ultrasonography (32%). The overall proportion of patients who went to surgical exploration and were resected was 89%. Of the patients undergoing diagnostic laparoscopy, metastatic disease that precluded resection was discovered in 37.6%. For patients who underwent diagnostic laparoscopy and were not resected, vascular invasion was the most common determinant of irresectability (66.6%). In multivariate analysis, preoperative weight loss and surgeon decision to use laparoscopy predicted irresectability at laparotomy. Conclusions. This study demonstrates that surgeon appear to use laparoscopy in a subset of patients at high risk for metastatic disease. The combination of current staging techniques is associated with a high proportion of resectability for patients taken to surgical exploration.


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