Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Centre for Pancreatico-Biliary Diseases, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland.
Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Centre for Pancreatico-Biliary Diseases, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland,
Dig Surg. 2019;36(3):251-260. doi: 10.1159/000488372. Epub 2018 Apr 12.
The study aimed to determine the additional value of staging laparoscopy in patients with pancreatic cancer deemed potentially resectable based on computed tomography imaging.
A systematic literature search was performed using MEDLINE and the Cochrane Register of Controlled Trials (January 1995 to June 2017). Primary outcome measures were the overall yield and sensitivity to detect non-resectable disease. Quality of studies was assessed with the Newcastle-Ottawa Scale.
From 156 records, 15 studies including 2,776 patients met the inclusion criteria. In 12 studies, reporting outcomes on 1,756 patients with resectable disease after standard imaging, 350 (20%, range 14-38%) cases of non-resectable cancer were detected with staging laparoscopy. In 3 studies on 242 patients with locally advanced disease after standard imaging, staging laparoscopy detected metastases in 86 patients (36%). The failure rate of staging laparoscopy to detect non-resectable disease was 5% (64 of 1,406).
Staging laparoscopy reduces the non-therapeutic laparotomy rate, and in locally advanced or borderline resectable disease, staging laparoscopy could more accurately select patients for neoadjuvant protocols.
本研究旨在确定对于基于计算机断层成像（CT）检查被认为具有潜在可切除性的胰腺癌患者，分期腹腔镜检查的附加价值。
采用 MEDLINE 和 Cochrane 对照试验登记库（1995 年 1 月至 2017 年 6 月）进行系统文献检索。主要结局指标为检测不可切除疾病的总体检出率和敏感性。采用纽卡斯尔-渥太华量表评估研究质量。
从 156 条记录中，有 15 项研究纳入了 2776 例患者，符合纳入标准。在 12 项研究中，对经过标准影像学检查后具有可切除性疾病的 1756 例患者进行了报告，分期腹腔镜检查发现了 350 例（20%，范围 14-38%）不可切除的癌症病例。在 3 项针对标准影像学检查后局部进展性疾病的 242 例患者的研究中，分期腹腔镜检查在 86 例患者（36%）中发现了转移灶。分期腹腔镜检查未能检测到不可切除疾病的失败率为 5%（1406 例中的 64 例）。
分期腹腔镜检查可降低非治疗性剖腹探查率，在局部进展性或边界可切除性疾病中，分期腹腔镜检查可更准确地选择接受新辅助方案的患者。
