Carbohydrate antigen 19.9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy

Laparoscopy with laparoscopic ultrasonography (L-LUS) may be useful in the selection of patients for surgery to resect peripancreatic malignancy in addition to contrast-enhanced computed tomography (CE-CT). The present prospective study assessed the strategy of using carbohydrate antigen 19.9 (CA19....

Full description

Saved in:
Bibliographic Details
Published in:British journal of surgery 2008-04, Vol.95 (4), p.453-459
Main Authors: HALLORAN, C. M, GHANEH, P, CONNOR, S, SUTTON, R, NEOPTOLEMOS, J. P, RARATY, M. G. T
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
CA-19-9 Antigen - metabolism
Digestive system. Abdomen
Endoscopy
Female
General aspects
Humans
Investigative techniques, diagnostic techniques (general aspects)
Laparoscopy - methods
Male
Medical sciences
Middle Aged
Pancreatic Neoplasms - blood
Pancreatic Neoplasms - diagnostic imaging
Pancreatic Neoplasms - surgery
Patient Selection
Predictive Value of Tests
Prospective Studies
Ultrasonography, Interventional - methods
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Laparoscopy with laparoscopic ultrasonography (L-LUS) may be useful in the selection of patients for surgery to resect peripancreatic malignancy in addition to contrast-enhanced computed tomography (CE-CT). The present prospective study assessed the strategy of using carbohydrate antigen 19.9 (CA19.9) levels to select patients for L-LUS. Patients with suspected peripancreatic malignancy that appeared resectable on CE-CT were selected for immediate surgery if CA19.9 was low (up to 150 kU/l, or up to 300 kU/l if serum bilirubin was above 35 micromol/l), or to L-LUS if CA19.9 was high (over 150 kU/l, or over 300 kU/l if serum bilirubin was above 35 micromol/l). Data were assessed to determine the clinical utility of this strategy. A total of 94 patients went straight to surgery, of whom 65 proved resectable: 63 of 80 with a low CA19.9 level but only two of 14 with a high CA19.9 level and gastric outlet obstruction. From 55 patients with high CA19.9 levels, L-LUS correctly identified 26 of 31 resectable tumours and eight of 24 unresectable tumours. Using CA19.9 levels to help select patients with pancreatic malignancy for immediate surgery or L-LUS for further assessment of resectability effectively increased resection rates and reduced unnecessary laparotomies.
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.6043