The researchers determined the value of laparoscopy in the management of periampullary tumors, and reported their findings in the latest issue of the Journal of Gastrointestinal Surgery.
A total of 144 patients with radiologically resectable nonpancreatic adenocarcinoma, periampullary tumors were identified from a prospective database between 1993 and 2000.
Criteria for laparoscopic unresectability included histologically proven peritoneal or hepatic metastases, distant nodal involvement, arterial involvement, and local extension outside the resection field.
Median age at operation was 70 years (range 31 to 87 years) and 56% of the patients were men.
An adequate laparoscopy was performed in 93% of the cases.
| Laparoscopy identifies an additional 10% of patients with unresectable disease.
| Journal of Gastrointestinal Surgery |
Laparoscopy identified 13 patients (10%) with unresectable disease.
Of 121 patients with laparoscopic resectable disease, 92% went on to subsequent resection; CT correctly predicted resectability in 82%.
It was found that laparoscopy spared 36% of unresectable patients a nontherapeutic laparotomy.
Patients with resectable disease were treated by pancreaticoduodenectomy (n = 91, 76%), ampullectomy (n = 12, 10%), duodenal resection (n = 10, 9%), or bile duct excision (n = 6, 5%).
Dr Ari D. Brooks, of the Memorial Sloan-Kettering Cancer Center, New York, said on behalf of fellow authors, "The addition of diagnostic laparoscopy to dynamic CT scanning in this selected patient population identifies an additional 10% of patients with unresectable disease."
"We believe that laparoscopy should be used in a selective manner for preoperative staging of patients suspected of having nonpancreatic periampullary tumors," it was concluded.