Original CommunicationThe platelet-lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer
Section snippets
Material and methods
Details of all referrals between January 1997 and September 2006 with suspected pancreatic and periampullary malignancy were collected prospectively and maintained in a database. Patients undergoing contrast-enhanced computed tomography (CT) were identified to select patients with radiologically resectable disease. Decision-making regarding tumor resectability was undertaken during a weekly multidisciplinary team meeting. The principal CT criteria used to determine resectability were based on
Statistical analysis
Continuous data were described using the median and interquartile range (IQR) with 2-tailed Mann-Whitney U testing or Kruskal-Wallis testing for comparative analysis. Categorical data were analyzed using chi-squared (χ2) or Fisher exact. Receiver operating characteristic (ROC) curves were used to analyse whether serum CA19-9 levels or platelet-lymphocyte ratios conferred superior predictive information with regard to tumor resectability. Adjusted CA19-9 levels were calculated for these analyses
Results
A total of 1056 patients were recorded in the database during the study period; 675 patients were identified with CT resectable or borderline resectable pancreatic or periampullary tumors of whom 336 underwent staging laparoscopy. A total of 263 patients from this group went on to laparotomy with a resection rate of 72% (190/263). The median interval between laparoscopy and operation was 14 days (IQR, 7 to 28 days). The histologic diagnoses recorded in this group are shown in Table I. A total
Discussion
Laparoscopic staging has been demonstrated to influence decision-making regarding operative intervention in approximately 15% of patients with radiologically resectable periampullary malignancy.5, 22 Use of staging laparoscopy can minimize potentially unnecessary operative intervention in patients with locally advanced and metastatic disease missed by CT imaging and facilitate earlier administration of the most appropriate palliative therapy.23, 24, 25, 26 Although endoscopic ultrasonography
References (41)
- et al.
Predicting resectability of periampullary cancer with three-dimensional computed tomography
J Gastrointest Surg
(2004) - et al.
A new strategy for the application of CA19-9 in the differentiation of pancreato-biliary cancer: analysis using a receiver operating characteristic curve
Am J Gastroenterol
(1999) - et al.
CA19-9 levels predict results of staging laparoscopy in pancreatic cancer
J Gastrointest Surg
(2005) - et al.
Increased preoperative platelet count is associated with decreased survival after resection for adenocarcinoma of the pancreas
Am J Surg
(2005) - et al.
Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review
Clin Gastroenterol Hepatol
(2006) - et al.
The value of laparoscopy in the management of ampullary, duodenal and distal bile duct tumours
J Gastrointest Surg
(2002) - et al.
Laparoscopic modified Devine exclusion gastrojejunostomy as a palliative surgery to relieve malignant pyloroduodenal obstruction by unresectable cancer
Am J Surg
(2007) - et al.
Paradoxical effects of cytokines in tumor immune surveillance and tumor escape
Cytokine Growth Factor Rev
(2007) - et al.
Tumor-associated transforming growth factor-beta and interleukin-10 contribute to a systemic Th2 immune phenotype in pancreatic carcinoma patients
Am J Pathol
(1999) - et al.
Thrombocytosis associated with poor prognosis in patients with oesophageal carcinoma
J Am Coll Surg
(2004)
Current standards of surgery for pancreatic cancer
Br J Surg
Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis
J Comput Assist Tomogr
Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours
Br J Surg
Laparoscopy and laparoscopic ultrasound in the evaluation of pancreatic and periampullary tumours
Dig Surg
Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies
Ann Surg
Experience with laparoscopic ultrasonography for defining tumour resectability in carcinoma of the pancreatic head and peri-ampullary region
Br J Surg
Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies
Anticancer Res
Serum CA19-9 measurement increases the effectiveness of staging laparoscopy in patients with suspected pancreatic malignancy
Dig Surg
Utility of tumour markers in determining resectability of pancreatic cancer
Arch Surg
CA19–9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy
Br J Surg
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Supported by Cancer Research UK.