TNM staging and assessment of resectability of pancreatic cancer by laparoscopic ultrasonography

Background: Laparoscopic ultrasonography (LUS) is an imaging modality that combines laparoscopy and ultrasonography. The purpose of this prospective b linded study was to evaluate the TNM stage and assessment of resectability by LUS in patients with pancreatic cancer. Methods: Of the 71 consecutive patients admitted to our department, 36 were excluded from the study, mainly due to evident signs of metastatic disease or another condition that would preclude surgery. Thus, a total of 35 pati ents were enrolled in the study. All patients underwent abdominal CT scan, ultrasonography, endoscopic ultrasonography (EUS), diagnostic laparoscopy, and LUS. Histopathologic examination was considered to be the final evaluat ion for LUS in all but three patients, where EUS was used as the reference. Results: The accuracy of LUS in T staging was 29/33 (80%); in N staging it was 22/34 (76%); in M staging, it was 23/34 (68%); and in overall TNM stagi ng, it was 23/34 (68%). In assessment of nonresectability, distant metastas es, and lymph node metastases, the sensitivity was 0.86, 0.43 and 0.67, res pectively, for LUS alone. Combining the information gleaned from laparoscop y and LUS, the accuracy in finding nonresectable tumors was 89%. Conclusions: Diagnostic laparoscopy with LUS is highly accurate in TNM stag ing and assessment of resectability of pancreatic cancer and should be cons idered an important modality in the assessment algorithm.