The impact of laparoscopy and laparoscopic ultrasonography on the management of pancreatic cancer

Hypothesis: Laparoscopy and laparoscopic ultrasonographic (LAPUS) examinati ons combined with a biopsy of the pancreatic lesion contribute significantl y in the determination of resectability of pancreatic cancer. Design: A prospective evaluation of the impact of laparoscopy and LAPUS on surgical decision making in patients with pancreatic cancer. Setting: A general community hospital; the department of surgery serves as referral for pancreatic surgery. Patients: During a 36-month period, 94 patients with pancreatic lesions wer e prospectively examined. Twenty-seven patients were found to have advanced disease. The remaining 67 patients were examined by laparoscopy and LAPUS to determine the resectability of the pancreatic tumor. Results: Laparoscopy and LAPUS contributed new, additional data in 40 patie nts (60%). Advanced disease was found in 30 patients, precluding curative r esection. The study indicated potentially resectable tumors in 37 patients (55%), including 3 defined by conventional imaging studies as probably unre sectable, and these patients were operated on with the intention of curativ e resection. Thirty-three patients underwent resection, and 4 (6%) were fou nd to have nonresectable disease and form the false-positive group of the s tudy. A summary of the results shows that the study resulted in a change of the decision regarding surgical intervention in 24 patients (36%) and avoi ded unnecessary laparotomies in 21 (31%). The study had a sensitivity of 10 0%, a specificity of 88%, and a false-positive rate of 6%. The positive pre dictive value of the study is 89%, and the negative predictive value is 100 %. Conclusions: Although rather invasive procedures that require general anest hesia and hospitalization, laparoscopy and LAPUS significantly contribute t o the staging of patients with potentially resectable pancreatic cancer, av oiding unnecessary explorative laparotomies. These procedures should be per formed in all patients with potentially resectable pancreatic cancer before explorative laparotomy.