EARLY EXPERIENCE OF LAPAROSCOPIC ULTRASONOGRAPHY IN THE MANAGEMENT OFPANCREATIC-CARCINOMA

A 7.5-MHz linear array ultrasound probe has been developed for the eva luation of solid organs at laparoscopy. Twelve patients with suspected carcinoma of the head of the pancreas, considered at initial investig ation to have resectable disease, were submitted to laparoscopy. In 4 patients, diagnostic laparoscopy revealed hepatic metastases (4 patien ts), peritoneal dissemination of tumor (2), and malignant ascites (1). Laparoscopic ultrasonography demonstrated hepatic metastases in four patients and hepatic cysts in two further patients. Ultrasound evaluat ion of the pancreas revealed lymphadenopathy (4 patients), local infil tration (2), and portal vein displacement or invasion (4). An anomalou s right hepatic artery arising from the superior mesenteric artery was identified in one patient. Overall, laparoscopy identified advanced d isease in four patients. Laparoscopic ultrasonography, while detecting advanced disease in a further two patients, predicted resectable dise ase in six patients (50%). Only one of the six patients submitted to l aparotomy was found to have irresectable disease due to lymph-node met astases. Laparoscopic ultrasound examination of the pancreas and liver has improved the early staging of pancreatic carcinoma and should be undertaken at an early stage in the management of such patients.