IMMEDIATE PREOPERATIVE LAPAROSCOPIC ASSESSMENT OF RESECTABILITY OF PANCREATIC HEAD CARCINOMA | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 22, Issue 1, January 2003, Page 31-36 PDF (308.93 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2003.374695 | ||||
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| Authors | ||||
| Abdel-Moneim A. Nagy; Ibrahim H. Othman* ; Ahmad A. Nofal; Ahmad I. Abd Allah; Soliman M. Soliman; Mustafa M. El-Sheikh | ||||
| Department of General Surgery, Faculty of Medicine, Tanta University | ||||
| Abstract | ||||
| To evaluate the role of laparoscopy in assessment of resectability of pancreatic head carcinoma, immediate preoperative laparoscopic staging was done for 18 patients with stage I disease. In absence of laparoscopic evidence contraindicating immediate operative treatment, resection was performed in the same sitting, but in presence of laparoscopic evidence of metastases, laparotomy was deferred and suitable biliary bypass was done later. Tumors in 12 patients (66.67%) were resectable. Tumors were resectable at laparotomy in 10 out of 12 patients (83.33%) as tumor infiltrated the portal vein in 1 patient (8.33%) and peripancreatic lymph nodes were involved in 1 patient (8.33%). The tumors were unresectable after staging laparoscopy in 6 patients (33.33%). Multiple hepatic nodules were present in 2 patients (11.11%), multiple small peritoneal metastases were present in 1 patient (5.56%), a nodule in the greater omentum was located in 1 patient (5.56%) and about 70-100 ml of ascites were aspirated from two patients (11.11%). Histopathological examination confirmed the presence of malignancy in the nodules and ascitic fluid in 1 patient while no malignancy was found in the ascitic fluid of the other patient. One patient developed mild infection at the trocar site and another patient developed mild bronchitis. We conclude that laparoscopic examination is a valuable routine undertaking before laparotomy and operative assessment of resectability in patients with pancreatic head cancer as it optimizes patient selection for curative resection by avoiding unnecessary laparotomies. It does not significantly increase either the hazards or the operative time and its performance immediately before laparotomy avoids repeated exposure to anesthesia and shortens hospitalization time. | ||||
| Keywords | ||||
| Laparoscopy staging; pancreatic head carcinoma | ||||
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