Address of Corresponding Author

Dig Surg 2005;22:80-85 (DOI: 10.1159/000085297)

  Key Words

• Computed tomography
• Surgery
• Resection
• Pancreas
• Cancer
• Tumour markers

  Abstract

Background/Aims: Staging laparoscopy for suspected pancreatic neoplasia is not widely accepted due to its low yield. The aim of this study was to determine if serum carbohydrate antigen (CA19-9) levels could be used to improve the selection of patients for staging laparoscopy. Methods: The data from a prospectively collected database (1997-2004) with 159 patients who had computed tomography-predicted resectable disease and who had undergone laparoscopic staging were analysed to determine if a low preoperative CA19-9 level (150 kU/l, or 300 kU/l with a bilirubin >35 µmol/l) identified patients in whom laparoscopy was not useful. Results: The CA19-9 level was >150 kU/l in 96 patients of whom 75 (78%) were considered resectable following laparoscopic assessment. There were 63 patients with a CA19-9 150 kU/l of whom 60 (95%) were considered resectable following laparoscopic assessment. The sensitivity, specificity, positive predictive value and negative predictive value for CA19-9 150 kU/l in predicting that laparoscopic assessment would judge patients as resectable were 44, 88, 95 and 22%, respectively. A cut-off level of 300 kU/l in patients with a bilirubin >35 µmol/l produced values of 30, 94, 94 and 28%, respectively. By using CA19-9 150 kU/l, laparoscopy could have been avoided in 40% of patients, increased to 55% of patients with adjustment for the presence of jaundice; concomitantly, the yield from laparoscopy would have been increased from 15 to 22 and 25%, respectively. Conclusion: Use of serum CA19-9 levels would increase the efficiency of laparoscopic staging in patients with suspected pancreatic malignancy.

Copyright © 2005 S. Karger AG, Basel

  Author Contacts

J.P. Neoptolemos, MB, BChir, MD, FRCS, Prof. of Surgery
Head, Department of Surgery, University of Liverpool
5th floor UCD Building, Royal Liverpool University Hospital
Daulby Street, Liverpool, L69 3GA (UK)
Tel. +44 151 706 4175, Fax +44 151 706 5826, E-Mail j.p.neoptolemos@liv.ac.uk

  Article Information

Received: July 16, 2004
Accepted: November 24, 2004
Published online: April 20, 2005
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 2, Number of References : 25