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. 1998 Aug;228(2):182–187. doi: 10.1097/00000658-199808000-00006

Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer.

E A Minnard 1, K C Conlon 1, A Hoos 1, E C Dougherty 1, L E Hann 1, M F Brennan 1
PMCID: PMC1191458  PMID: 9712562

Abstract

OBJECTIVE: To define the role of laparoscopic ultrasound (LUS) in the staging of pancreatic tumors. SUMMARY BACKGROUND DATA: Laparoscopy has recently been established as a valuable tool in the staging of pancreatic cancer. It has been suggested that the addition of LUS to standard laparoscopy could improve the accuracy of this procedure. METHODS: A prospective 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. Clinical, surgical, and pathologic data were collected. RESULTS: The median age was 65 years (range 43 to 85 years). Sixty-four patients had tumors in the head, 19 in the body, and 3 in the tail of the pancreas. Four patients had ampullary tumors. LUS was able to image the primary tumor (98%), portal vein (97%), superior mesenteric vein (94%), hepatic artery (93%), and superior mesenteric artery (93%) in these patients. LUS 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 laparoscopic examination was equivocal. CONCLUSIONS: LUS is useful in evaluating the primary tumor and peripancreatic vascular anatomy. When standard laparoscopic findings are equivocal, LUS allowed accurate determination of resectability. Supplementing laparoscopy with LUS offers improved assessment and preoperative staging of pancreatic cancer.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ascher S. M., Evans S. R., Zeman R. K. Laparoscopic cholecystectomy: intraoperative ultrasound of the extrahepatic biliary tree and the natural history of postoperative transabdominal ultrasound findings. Semin Ultrasound CT MR. 1993 Oct;14(5):331–337. doi: 10.1016/s0887-2171(05)80052-6. [DOI] [PubMed] [Google Scholar]
  2. Bernheim B. M. IV. Organoscopy: Cystoscopy of the Abdominal Cavity. Ann Surg. 1911 Jun;53(6):764–767. doi: 10.1097/00000658-191106000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bismuth H., Castaing D., Garden O. J. The use of operative ultrasound in surgery of primary liver tumors. World J Surg. 1987 Oct;11(5):610–614. doi: 10.1007/BF01655836. [DOI] [PubMed] [Google Scholar]
  4. Callery M. P., Strasberg S. M., Doherty G. M., Soper N. J., Norton J. A. Staging laparoscopy with laparoscopic ultrasonography: optimizing resectability in hepatobiliary and pancreatic malignancy. J Am Coll Surg. 1997 Jul;185(1):33–39. [PubMed] [Google Scholar]
  5. Cameron J. L., Pitt H. A., Yeo C. J., Lillemoe K. D., Kaufman H. S., Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993 May;217(5):430–438. doi: 10.1097/00000658-199305010-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carter D. C. Cancer of the pancreas. Gut. 1990 May;31(5):494–496. doi: 10.1136/gut.31.5.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Conlon K. C., Dougherty E., Klimstra D. S., Coit D. G., Turnbull A. D., Brennan M. F. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg. 1996 Feb;223(2):134–140. doi: 10.1097/00000658-199602000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cuesta M. A., Meijer S., Borgstein P. J. Laparoscopy and assessment of digestive tract cancer. Br J Surg. 1992 Jun;79(6):486–487. doi: 10.1002/bjs.1800790605. [DOI] [PubMed] [Google Scholar]
  9. Cuschieri A. Laparoscopy for pancreatic cancer: does it benefit the patient? Eur J Surg Oncol. 1988 Feb;14(1):41–44. [PubMed] [Google Scholar]
  10. Fuhrman G. M., Charnsangavej C., Abbruzzese J. L., Cleary K. R., Martin R. G., Fenoglio C. J., Evans D. B. Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg. 1994 Jan;167(1):104–113. doi: 10.1016/0002-9610(94)90060-4. [DOI] [PubMed] [Google Scholar]
  11. Hünerbein M., Rau B., Schlag P. M. Laparoscopy and laparoscopic ultrasound for staging of upper gastrointestinal tumours. Eur J Surg Oncol. 1995 Feb;21(1):50–55. doi: 10.1016/s0748-7983(05)80068-x. [DOI] [PubMed] [Google Scholar]
  12. Ishida H., Dohzono T., Furukawa Y., Kobayashi M., Tsuneoka K. Laparoscopy and biopsy in the diagnosis of malignant intra-abdominal tumors. Endoscopy. 1984 Jul;16(4):140–142. doi: 10.1055/s-2007-1018559. [DOI] [PubMed] [Google Scholar]
  13. Ishida H. Peritoneoscopy and pancreas biopsy in the diagnosis of pancreatic diseases. Gastrointest Endosc. 1983 Aug;29(3):211–218. doi: 10.1016/s0016-5107(83)72587-3. [DOI] [PubMed] [Google Scholar]
  14. John T. G., Greig J. D., Carter D. C., Garden O. J. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg. 1995 Feb;221(2):156–164. doi: 10.1097/00000658-199502000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Machi J., Sigel B., Zaren H. A., Kurohiji T., Yamashita Y. Operative ultrasonography during hepatobiliary and pancreatic surgery. World J Surg. 1993 Sep-Oct;17(5):640–646. doi: 10.1007/BF01659130. [DOI] [PubMed] [Google Scholar]
  16. Palazzo L., Roseau G., Gayet B., Vilgrain V., Belghiti J., Fékéte F., Paolaggi J. A. Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy. 1993 Feb;25(2):143–150. doi: 10.1055/s-2007-1010273. [DOI] [PubMed] [Google Scholar]
  17. Parker S. L., Tong T., Bolden S., Wingo P. A. Cancer statistics, 1996. CA Cancer J Clin. 1996 Jan-Feb;46(1):5–27. doi: 10.3322/canjclin.46.1.5. [DOI] [PubMed] [Google Scholar]
  18. Plainfosse M. C., Bouillot J. L., Rivaton F., Vaucamps P., Hernigou A., Alexandre J. H. The use of operative sonography in carcinoma of the pancreas. World J Surg. 1987 Oct;11(5):654–658. doi: 10.1007/BF01655843. [DOI] [PubMed] [Google Scholar]
  19. Reznek R. H., Stephens D. H. The staging of pancreatic adenocarcinoma. Clin Radiol. 1993 Jun;47(6):373–381. doi: 10.1016/s0009-9260(05)81056-6. [DOI] [PubMed] [Google Scholar]
  20. Ross C. B., Sharp K. W., Kaufman A. J., Andrews T., Williams L. F. Efficacy of computerized tomography in the preoperative staging of pancreatic carcinoma. Am Surg. 1988 Apr;54(4):221–226. [PubMed] [Google Scholar]
  21. Warshaw A. L., Gu Z. Y., Wittenberg J., Waltman A. C. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg. 1990 Feb;125(2):230–233. doi: 10.1001/archsurg.1990.01410140108018. [DOI] [PubMed] [Google Scholar]
  22. Warshaw A. L., Tepper J. E., Shipley W. U. Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg. 1986 Jan;151(1):76–80. doi: 10.1016/0002-9610(86)90015-2. [DOI] [PubMed] [Google Scholar]
  23. Watanabe M., Takatori Y., Ueki K., Umekawa Y., Yoshida H., Kobatake T., Hirakawa H., Fukumoto S., Shimada Y. Pancreatic biopsy under visual control in conjunction with laparoscopy for diagnosis of pancreatic cancer. Endoscopy. 1989 Mar;21(2):105–107. doi: 10.1055/s-2007-1012912. [DOI] [PubMed] [Google Scholar]
  24. Watanapa P., Williamson R. C. Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg. 1992 Jan;79(1):8–20. doi: 10.1002/bjs.1800790105. [DOI] [PubMed] [Google Scholar]
  25. Yasuda K., Mukai H., Fujimoto S., Nakajima M., Kawai K. The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc. 1988 Jan-Feb;34(1):1–8. doi: 10.1016/s0016-5107(88)71220-1. [DOI] [PubMed] [Google Scholar]
  26. de Rooij P. D., Rogatko A., Brennan M. F. Evaluation of palliative surgical procedures in unresectable pancreatic cancer. Br J Surg. 1991 Sep;78(9):1053–1058. doi: 10.1002/bjs.1800780909. [DOI] [PubMed] [Google Scholar]
  27. van Heerden J. A., Grant C. S., Czako P. F., Service F. J., Charboneau J. W. Occult functioning insulinomas: which localizing studies are indicated? Surgery. 1992 Dec;112(6):1010–1015. [PubMed] [Google Scholar]

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