LAPAROSCOPIC ULTRASOUND ENHANCES STANDARD LAPAROSCOPY IN THE STAGING OF PANCREATIC-CANCER

Objective To define the role of laparoscopic ultrasound (LUS) in the s taging of pancreatic tumors. Summary Background Data Laparoscopy has r ecently been established as a valuable tool in the staging of pancreat ic cancer. It has been suggested that the addition of LUS to standard laparoscopy could improve the accuracy of this procedure. Methods A pr ospective evaluation of 90 patients with pancreatic tumors undergoing laparoscopy and LUS was performed over a 27-month period. LUS equipped with an articulated curved and linear array transducer (6 to 10 MHz) was used. All patients underwent rigorous laparoscopic examination, Cl inical, surgical, and pathologic data were collected. Results The medi an age was 65 years (range 43 to 85 years). Sixty-four patients had tu mors in the head, 19 in the body, and 3 in the tail of the pancreas. F our patients had ampullary tumors. LUS was able to image the primary t umor (98%), and superior mesenteric artery (93%) in these patients. LU S was particularly helpful in determining venous involvement (42%) and arterial involvement (38%) by the tumor. This resulted in a change in surgical treatment for 13 (14%) of the 90 patients in whom standard l aparoscopic examination was equivocal. Conclusions LUS is useful in ev aluating the primary tumor and peripancreatic vascular anatomy. When s tandard laparoscopic findings are equivocal, LUS allowed accurate dete rmination of resectability. Supplementing laparoscopy with LUS offers improved assessment and preoperative staging of pancreatic cancer. Con clusions LUS is useful in evaluating the primary tumor and peripancrea tic vascular anatomy. When standard laparoscopic findings are equivoca l, LUS allowed accurate determination of resectability. Supplementing laparoscopy with LUS offers improved assessment and preoperative stagi ng of pancreatic cancer.