Experience with laparoscopic ultrasonography for defining tumour resectability in carcinoma of the pancreatic head and periampullary region

Background: Computed tomography (CT) is currently the most widely available staging investigation for pancreatic tumours. However, the accuracy of CT for determining tumour resectability is variable and can be poor. Laparosco pic ultrasonography (LUS) is potentially a more accurate method for disease staging. The authors' experience of LUS for staging carcinoma of the pancr eatic head and periampullary region is described. Methods: Fifty-one patients with potentially resectable pancreatic tumours defined at CT underwent further investigation with LUS. Twenty-seven patien ts subsequently had an open laparotomy. The evaluations of tumour resectabi lity at CT and LUS were compared with the operative findings. Results: At LUS, 24 patients were considered to have resectable tumours, 21 non-resectable tumours and six patients were shown to have no pancreatic t umour mass. Twenty-two patients deemed to have a resectable tumour at LUS u nderwent surgery. Twenty patients were confirmed to have resectable disease and two patients had non-resectable disease. A further five patients under went surgery. In all five the ultrasonographic diagnosis was confirmed at s urgery (four patients with non-resectable disease and no pancreatic tumour in one patient). LUS prevented unnecessary extensive surgery in 53 per cent of patients. For the 22 patients who underwent surgery for potentially res ectable disease, the positive predictive value of LUS for defining tumour r esectability was 91 per cent. Conclusion: LUS is an accurate additional investigation for defining tumour resectability and directing management in patients with potentially resect able carcinoma of the pancreatic head or periampullary region.