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. 2006 Jan 30;94(2):213-7.
doi: 10.1038/sj.bjc.6602919.

Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours

B N J Thomson  1 , R W Parks, D N Redhead, F K S Welsh, K K Madhavan, S J Wigmore, O J Garden
Affiliations

Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours

B N J Thomson et al. Br J Cancer. .

Abstract

Laparoscopy and laparoscopic ultrasound have been validated previously as staging tools for pancreatic cancer. The aim of this study was to identify if assessment of vascular involvement with abdominal computed tomography (CT) would allow refinement of the selection criteria for laparoscopy and laparoscopic ultrasound (LUS). The details of patients staged with LUS and abdominal CT were obtained from the unit's pancreatic cancer database. A CT grade (O, A-F) of vascular involvement was recorded by a single radiologist. Of 152 patients, who underwent a LUS, 56 (37%) had unresectable disease. Three of 26 (12%) patients with CT grade O, 27 of 88 (31%) patients with CT grade A to D, 17 of 29 (59%) patients with CT grade E and all nine patients with CT grade F were found to have unresectable disease. In all, 24% of patients with tumours <3 cm were found to have unresectable disease. In those patients with tumours considered unresectable, local vascular involvement was found in 56% of patients and vascular involvement with metastatic disease in 17%, while 20% of patients had liver metastases alone and 5% had isolated peritoneal metastases. The remaining patient was deemed unfit for resection. Selective use of laparoscopic ultrasound is indicated in the staging of periampullary tumours with CT grades A to D.

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Figures

Figure 1
Figure 1
Laparoscopic ultrasound assessment of vascular invasion. (A) Resectable tumour free from splenoportal junction. (B) Tumour involvement of splenoportal junction. (C) Tumour involvement of the superior mesenteric artery (BD – bile duct, PD – pancreatic duct, SP – splenoportal junction, SMA – superior mesenteric artery).
Figure 2
Figure 2
Reason unresectable at laparoscopic ultrasound.
Figure 3
Figure 3
Tumour size on CT for grades A–D and the proportion resectable (88 patients).
See this image and copyright information in PMC

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