ASSESSMENT OF DISSEMINATED PANCREATIC-CANCER - A COMPARISON OF TRADITIONAL EXPLORATORY LAPAROTOMY AND RADIOIMMUNOGUIDED SURGERY

Background. After curative resection for pancreatic cancer; only 10% o f patients survive disease for 5 years. These dismal results suggest t he presence of occult tumor at the time of initial operation. This pha se I/II study was conducted to compare traditional exploratory laparot omy with radioimmunoguided surgery (RIGS) in the assessment of dissemi nated pancreatic cancer Methods. Ten patients with the diagnosis of ad enocarcinoma of the pancreas were injected intravenously with 1 mg CC4 9 monoclonal antibody radiolabeled with 2 mCi iodine 125. All patients were evaluated by a standard abdominal exploration followed by RIGS. Tumor identified by each technique was documented and categorized as n eoplasm disseminated to viscera or lymphatics. Results, There were 25 visceral sites of disease that were traditionally discovered at the ti me of exploration including pancreas, omentum, small bowel, pelvis, li ver, and other All 25 sites of disease were positive by RIGS plus an a dditional four sites of visceral tumor for a total of 29 RIGS positive sites of disease. Six lymphatic sites of disease were discovered by t raditional examination; however, 44 sites of lymphatic sites were docu mented by RIGS (p < 0.001). In addition, nine traditionally and pathol ogically negative/RIGS positive nodes were subjected to cytokeratin an d MOC 31 immunohistochemistry. Six of nine nodes were positive by cyto keratin immunohistochemistry, and five of the six cytokeratin positive nodes were MOC 31 positive. Conclusions, These data suggest that the RIGS technique detected significantly more foci of visceral spread of tumor than traditional exploratory laparotomy and significantly more s ites of lymphatic dissemination were identified by RIGS than by standa rd exploration.