MULTIMODALITY STAGING OPTIMIZES RESECTABILITY IN PATIENTS WITH PANCREATIC AND AMPULLARY CANCER

Few patients with pancreatic cancer have resectable disease at the tim e of diagnosis, and a variety of nonsurgical techniques are available to provide effective palliation of jaundice and pain. Accurate preoper ative staging is essential to identify patients with unresectable dise ase, thereby minimizing unnecessary surgery. Currently used diagnostic tests include contrast-enhanced computerized tomography (CT), viscera l angiography, endoscopic ultrasound, and laparoscopy, but their utili ty remains controversial. To evaluate the accuracy of these various di agnostic tests, 30 consecutive patients with histologically proven pan creatic or ampullary adenocarcinoma treated between 1992 and 1996 were evaluated. All 30 patients had contrast-enhanced CT and laparoscopy, 22 patients (73%) had visceral angiography, and 16 patients (53%) had endoscopic ultrasound. Individual and combined predictive values of re sectability and unresectability as well as the sensitivities and speci ficities were determined for all diagnostic tests and compared with in traoperative findings. When CT, visceral angiography, and laparoscopy were combined, the predictive values of resectability and unresectabil ity were 75 and 90 per cent, respectively, with a sensitivity of 75 pe r cent and a specificity of 90 per cent. Therefore, the combined use o f selected diagnostic tests proved more effective than any single diag nostic test for accurately staging patients with pancreatic head and a mpullary cancers and should be considered to minimize unnecessary surg ery.