Utility of @entity5 markers in determining resectability of XXXX .

@entity1 @entity788 @entity66 @entity5 @entity3 @entity3638
HYPOTHESIS: Despite advances in preoperative radiologic imaging, a significant fraction of potentially resectable @entity788 are found to be unresectable at laparotomy. We tested the hypothesis that preoperative serum levels of CA19-9 ( @entity5 antigen) and carcinoembryonic antigen will identify @entity1 with unresectable @entity788 despite radiologic staging demonstrating resectable disease. DESIGN AND SETTING: Academic tertiary care referral center. @entity1 : From March 1, 1996, to July 31, 2002, 125 @entity1 were identified who underwent surgical exploration for potentially resectable @entity788 based on a preoperative computed tomographic scan; in 89 of them a preoperative @entity5 marker had been measured. MAIN OUTCOME MEASURES: Preoperative @entity5 markers (CA19-9 and carcinoembryonic antigen) were correlated with extent of disease at exploration. As CA19-9 is excreted in the biliary system, CA19-9 adjusted for the degree of @entity3638 was determined and analyzed. RESULTS: Of the 89 @entity1 , 40 (45%) had @entity66 and underwent resection, 25 (28%) had locally advanced (unresectable) disease, and 24 (27%) had @entity3 . The mean adjusted CA19-9 level was significantly lower in those with @entity66 than those with locally advanced (63 vs 592; P =.003) or metastatic (63 vs 1387; P<.001) disease. When a threshold adjusted CA19-9 level of 150 was used, the positive predictive value for determination of unresectable disease was 88%. Carcinoembryonic antigen level was not correlated with extent of disease. CONCLUSIONS: Among the @entity1 with resectable @entity788 based on preoperative imaging studies, those with abnormally high serum levels of CA19-9 may have unresectable disease. These @entity1 may benefit from additional staging modalities such as diagnostic laparoscopy to avoid unnecessary laparotomy.
