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Staging with helical computed tomography and laparoscopy in pancreatic head cancer
Takanori Yoshida1, Toshifumi Matsumoto, Yuji Morii
1Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita 871-8511, Japan.
Background/Aims:
Helical computed tomography provides valuable information about extent of pancreatic cancer. However, it remains difficult to detect small distant metastases. Laparoscopic examination is becoming standard for cancer staging.
Methodology:
Between 1995 and 1999, 45 patients with radiologically resectable pancreatic head cancer were analyzed retrospectively to clarify the indications for and role of staging laparoscopy. Computed tomography was examined for tumor size and spread to portal or superior mesenteric veins (PV) and celiac or superior mesenteric arteries (A).
Results:
There were 29 (64%) patients with resectable disease, 4 (9%) with localized unresectable, and 12 (27%) with metastatic (hepatic in 7 and peritoneal in 5). Patients with metastatic disease were more likely to present with abdominal pain, vomiting, and back pain than were patients with resectable disease (p < 0.05). The mean tumor size and involvement of PV or A were greater in metastatic patients than in resectable patients (p < 0.005 or p < 0.01). The survival rate for patients with metastatic disease was lower than that for patients with resectable disease (p < 0.0001).
Conclusions:
According to clinical features and computed tomography findings, laparoscopic exploration is recommended for cancer staging. Helical computed tomography and staging laparoscopy categorize patients into those with localized and those with metastatic disease which considerably correlated with survivals.