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Clinical Trial
. 2003 Jan;237(1):66-73.
doi: 10.1097/00000658-200301000-00010.

Laparoscopic staging and subsequent palliation in patients with peripancreatic carcinoma

Els J M Nieveen van Dijkum  1 , Mark G Romijn, Caroline B Terwee, Laurens Th de Wit, Jan H P van der Meulen, Han S Lameris, Erik A J Rauws, Huug Obertop, Casper H J van Eyck, Patrick M M Bossuyt, Dirk J Gouma
Affiliations
Clinical Trial

Laparoscopic staging and subsequent palliation in patients with peripancreatic carcinoma

Els J M Nieveen van Dijkum et al. Ann Surg. 2003 Jan.

Abstract

Objective: To test the hypothesis that laparoscopic staging improves outcome in patients with peripancreatic carcinoma compared to standard radiology staging.

Summary background data: Diagnostic laparoscopy of peripancreatic malignancies has been reported to improve assessment of tumor stage and to prevent unnecessary exploratory laparotomies in 10% to 76% of patients.

Methods: Laparoscopy and laparoscopic ultrasound were performed in 297 consecutive patients with peripancreatic carcinoma scheduled for surgery after radiologic staging. Patients with pathology-proven unresectable tumors were randomly allocated to either surgical or endoscopic palliation. All others underwent laparotomy.

Results: Laparoscopic staging detected biopsy-proven unresectable disease in 39 patients (13%). At laparotomy, unresectable disease was found in another 72 patients, leading to a detection rate for laparoscopic staging of 35%. In total, 145 of the 197 patients classified as having "possibly resectable" disease after laparoscopic staging underwent resection (74%). Average survival in the group of 14 patients with biopsy-proven unresectable tumors randomly allocated to endoscopic palliation was 116 days, with a mean hospital-free survival of 94 days. The corresponding figures were 192 days and 164 days in the 13 patients allocated to surgical palliation.

Conclusions: Because of the limited detection rate for unresectable metastatic disease and the likely absence of a large gain after switching from surgical to endoscopic palliation, laparoscopic staging should not be performed routinely in patients with peripancreatic carcinoma.

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Figures

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Figure 1. Flow chart of patients included for laparoscopic staging.
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Figure 2. Survival in patients with unresectable tumors allocated to endoscopic palliation (top) and surgical palliation (bottom).
See this image and copyright information in PMC

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