Computed tomography and laparoscopy in the assessment of the patient with pancreatic cancer

In most patients with pancreatic cancer, the tumor is unresectable. Nonoperative methods for palliation of jaundice, duodenal obstruction, and pain currently are being developed. Preoperative assessment of resectability of the tumor is becoming more and more important to avoid unnecessary operations. The aim of this study was to compare computed tomography (CT) and laparoscopy with special reference to the additive role of the latter technique in predicting unresectability of pancreatic cancers.

Sixty patients with exocrine pancreatic cancer were assessed prospectively with both CT and laparoscopy. On the basis of metastatic spread or signs of vascular involvement, the radiologist and the laparoscopist independently reported the tumors as probably unresectable or resectable.

The predictive value for unresectability was 100% for both CT and laparoscopy. Sensitivity in predicting unresectability was 69% for both techniques, and the corresponding figure for specificity was 100%. When CT and laparoscopy were evaluated together, an improvement in sensitivity to 87% was observed (p < 0.05). Separately, CT and laparoscopy correctly predicted resectability in only 30% and 38% of the patients, respectively. The presence of liver metastases was overlooked by CT in 13 of 32 patients (40%). Every fourth patient who was found to have unresectable tumor at CT was falsely classified as resectable by the laparoscopist, leading to unnecessary laparotomies. On the other hand, 9 of 24 patients (38%) with resectable disease at CT were deemed unresectable at the subsequent laparoscopy.

Laparoscopy and CT independently and reliably predicted unresectability of pancreatic cancer, but the methods were inaccurate in forecasting resectability. The results suggest that CT examination should be done in patients who are candidates for attempted curative surgical procedures, whereas laparoscopy should be restricted to Those Judged resectable at CT.