2005 Abstracts: Combined Role of Diagnostic Laparoscopy and CA19-9 Level in Staging of Pancreatic Cancer
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Combined Role of Diagnostic Laparoscopy and CA19-9 Level in Staging of Pancreatic Cancer
Andreas Karachristos, Temple University Hospital, Philadelphia, PA; Sam Litwin, Fox-Chase Cancer Center, Philadelphia, PA; John Hoffman, Fox-Chase, Philadelphia, PA
Laparoscopy has emerged as an important staging procedure for determining resectability of pancreatic cancer. However, a small fraction of patients with pancreatic cancer benefit from its use and therefore the routine application of laparoscopy remains controversial. We hypothesized that serum CA19-9 levels may identify patients that will or will not benefit by laparoscopy
We retrospectively review our database of 63 patients with pancreatic adenocarcinoma who underwent staging laparoscopy and correlated findings with CA19-9 levels. According to imaging studies two groups were identified. Group 1 included 27 patients (43%) without evidence of metastatic disease and resectable tumors and Group 2 comprised 36 (57%) without metastasis but locally advanced tumors. Group 1 underwent laparoscopy followed by laparotomy if laparoscopy was negative and group 2 had laparoscopy and if negative were entered to a protocol of neoadjuvant chemoradiation. Overall laparoscopy identified metastatic disease in 12 patients (19%). None of those required any further operation. The resectability rate (patients that underwent resection after laparoscopy) was 73.5%. The resectability rate in Group 1 was 83%. There was one false negative laparoscopy (1.6%). No patient with CA19-9 level below 100 had metastasis revealed by laparoscopy.18 patients (28.6%) had levels below this cut-off point and could have avoided laparoscopy, increasing its yield to 26.7%. The resectability rate in patients with CA19-9 levels below 100 was 77.8% and those above 51.2% (p= 0.054). The sensitivity of CA19-9 using as cut-off the level 100 was 92%, the specificity 44%. Patients with elevated CA19-9 had increased probability of metastatic disease detected by laparoscopy (O.R. = 1.40), although this result did not reach statistical significance (p= 0.08, C.I. =0.95-2.1). In patients with adenocarcinoma of the pancreas, low CA19-9 levels predict low probability of metastatic disease and therefore in those patients laparoscopy can be spared. On the contrary patients with elevated CA19-9 have increased probability of metastatic disease and these patients may benefit from diagnostic laparoscopy.
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