Stefanidis D, Grove K D, Schwesinger W H, Thomas C R
Tulane Center for Minimally Invasive Surgery, Tulane University Health Sciences Center, New Orleans, LA, USA.
Ann Oncol. 2006 Feb;17(2):189-99. doi: 10.1093/annonc/mdj013. Epub 2005 Oct 19.
In the absence of metastatic disease patients with localized or locally advanced pancreatic cancer can benefit from surgical resection or chemoradiation. Despite the advances of imaging technology, however, noninvasive staging modalities are still inaccurate in identifying small volume metastatic disease leading potentially to inappropriate treatment and avoidable morbidity in a subgroup of patients. Staging laparoscopy may identify those patients with unsuspected metastatic disease on preoperative imaging and prevent unnecessary laparotomy or chemoradiation. A controversy exists, however, as to whether the procedure should be used routinely or selectively in pancreatic cancer patients with no evidence of metastasis on noninvasive staging. This review aims to assess the current role of staging laparoscopy by examining its diagnostic accuracy and ability to prevent unnecessary treatment as well as its morbidity, oncologic effect and cost-effectiveness. The available literature will be evaluated critically, its limitations identified and exisiting controversies addressed.
对于无转移性疾病的局限性或局部进展期胰腺癌患者，手术切除或放化疗可能有益。然而，尽管成像技术有所进步，但非侵入性分期方法在识别小体积转移性疾病方面仍然不准确，这可能导致部分患者接受不适当的治疗并出现可避免的发病率。分期腹腔镜检查可识别那些术前影像学检查未发现转移性疾病的患者，并避免不必要的剖腹手术或放化疗。然而，对于在非侵入性分期中无转移证据的胰腺癌患者，该检查是应常规使用还是选择性使用存在争议。本综述旨在通过检查分期腹腔镜检查的诊断准确性、预防不必要治疗的能力以及其发病率、肿瘤学效果和成本效益，来评估其当前的作用。将对现有文献进行严格评估，确定其局限性并解决现有争议。
