@entity189 of the pancreatic head and periampullary region. XXXX staging with laparoscopy and laparoscopic ultrasonography.

@entity1 @entity3123 @entity5 @entity9451 @entity189
OBJECTIVE: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in @entity1 with @entity189 of the pancreatic head and periampullary region. SUMMARY BACKGROUND DATA: Pancreatic resection with curative intent is possible in a select minority of @entity1 who have @entity189 of the pancreatic head and periampullary region. @entity1 selection is important to plan appropriate therapy and avoid unnecessary laparotomy in @entity1 with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of @entity9451 . METHODS: A cohort of 40 consecutive @entity1 referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or @entity5 underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting @entity5 resectability (absence of peritoneal or liver metastases; absence of @entity5 ; @entity5 confined to pancreatic head or periampullary region). RESULTS: "Occult" metastatic lesions were demonstrated by staging laparoscopy in 14 @entity1 (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable @entity5 in 23 @entity1 (59%), provided staging information in addition to that of laparoscopy alone in 20 @entity1 (53%), and changed the decision @entity5 resectability in 10 @entity1 (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting @entity5 resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively). CONCLUSIONS: Staging laparoscopy is indispensable in the detection of "occult" intra-abdominal metastases. Laparoscopic ultrasonography improves the accuracy of @entity5 in @entity1 with potentially resectable @entity3123 .
