The use of laparoscopic ultrasound in the assessment of pancreatic cancer

Abstract

26 consecutive cases of obstructive jaundice due to a carcinoma of the head of the pancreas were studied prospectively with ultrasound (US), computerized tomography (CT), endoscopic ultrasonography (EUS) and laparoscopic ultrasound (LUS). Sensitivity of US, CT were comparable, although CT seems better to evaluate the size of the tumor and for lymph node detection. 50 percent of patients had a criterion for noncurative resection. EUS (16 cases) had the best sensitivity (100 percent) for the staging of small tumors (less than 20 mm), detection of adjacent nodes and the relation between tumors- and mesenteric and portal vein. EUS was not able to detect peritoneal and/or liver micro-metastases. The criterion for noncurative resection was 57.6%. LUS exactly assessed all tumors larger than 2 cm. The accuracy compared with EUS was not as good for small tumors, but better concerning micro-peritoneal or hepatic metastasis. The criterion for noncurative resection was 80.7 percent. These results suggest to use of US and CT as first-line procedures in the preoperative staging and assessment of resectability of pancreatic cancers. When the patient does not appear to have disseminated lesions, EUS gives a good estimation of the size of the tumor, node assessment and vascular relations. LUS could be the first step for a curative surgical treatment. LUS revelated to discover 15 to 30 percent of unknown micro-metastases and avoided useless laparotomy in these patients.