Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA.
Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA.
J Am Coll Surg. 2014 Jun;218(6):1201-6. doi: 10.1016/j.jamcollsurg.2014.02.018. Epub 2014 Feb 28.
The role of staging laparoscopy in pancreatic cancer in the age of high-resolution CT scans is under debate. This study's aim is to evaluate the efficacy of staging laparoscopy in this disease.
A retrospective cohort study was conducted evaluating patients who underwent operative treatment for radiographic stage I to III pancreatic cancer between July 2003 and October 2012. Radiographic follow-up was 94% at 6 months.
Of 274 patients who met inclusion criteria, 136 underwent staging laparoscopy, which identified radiographic occult distant metastases in 2% (3 of 136). However, subsequent laparotomy identified an additional 9% (12 of 136) harboring distant metastases in regions not visualized on standard staging laparoscopy; specifically, the posterior liver surface, paraduodenal retroperitoneum, proximal jejunal mesentery, and lesser sac. The remaining 138 patients underwent initial staging laparotomy, which showed similar results identifying radiographic occult distant disease in 11% (15 of 138). Within 6 months after the operation, peritoneal or subcapsular liver metastases developed in an additional 6% (15 of 257)-disease that potentially could have been diagnosed at the time of operation-providing a false-negative rate of 88% for staging laparoscopy compared with 36% for staging laparotomy.
Despite the availability of high-resolution CT scans, occult distant metastases can still be found in 11% of patients during the operation. In the absence of reliable risk factors to predict distant metastases, staging laparoscopy should be offered to all patients with radiographic localized disease. However, the results favor extended laparoscopic staging with evaluation of the posterior liver surface, mobilization of the duodenum, evaluation of the proximal jejunal mesentery, and visualization of the lesser sac.
在高分辨率 CT 扫描时代，腹腔镜分期在胰腺癌中的作用仍存在争议。本研究旨在评估腹腔镜分期在该疾病中的疗效。
回顾性队列研究评估了 2003 年 7 月至 2012 年 10 月期间接受影像学 I 期至 III 期胰腺癌手术治疗的患者。影像学随访 6 个月时的比例为 94%。
符合纳入标准的 274 例患者中，136 例行腹腔镜分期，其中 2%（3/136）发现影像学隐匿性远处转移。然而，随后的剖腹探查发现，在标准腹腔镜分期未显示的区域存在额外的 9%（12/136）远处转移；具体而言，为肝后表面、十二指肠旁后腹膜、近端空肠系膜和小网膜。其余 138 例患者行初始分期剖腹手术，结果显示 11%（15/138）影像学隐匿性远处疾病。术后 6 个月内，腹膜或包膜下肝转移发展的比例为 6%（15/257）——这些疾病本可以在手术时诊断出来——与分期剖腹手术的 36%相比，腹腔镜分期的假阴性率为 88%。
尽管有高分辨率 CT 扫描，但在手术过程中仍有 11%的患者发现隐匿性远处转移。在缺乏可靠的预测远处转移的风险因素的情况下，应向所有影像学局限性疾病患者提供腹腔镜分期。然而，结果有利于扩大腹腔镜分期，评估肝后表面、十二指肠游离、近端空肠系膜评估和小网膜可视化。
