The aims of this thesis were to validate staging laparoscopy, laparoscopic ultrasonography (LapUS), and laparoscopic peritoneal cytology (LPC) in the staging of patients presenting with pancreatic or periampullary carcinoma. A series of studies was performed over a period of 52 months between 1991 and 1995 to evaluate the efficacy of these techniques. A systematic method for LapUS examination of the liver, biliary tree and pancreas was devised. In Study 1, the ability of LapUS to image defined anatomical landmarks was evaluated during (i) laparoscopic cholecystectomy, and (ii) staging laparoscopy for pancreatic malignancy. Satisfactory imaging of all anatomical structures considered important was shown to be feasible using LapUS. In Study 2, staging laparoscopy with LapUS was performed in forty patients with pancreatic or periampullary carcinomas otherwise considered to be potentially resectable on the basis of transabdominal ultrasonography (USS) and/or computerised tomography (CT). Occult metastatic lesions were demonstrated by laparoscopy in 14 patients (35%). Following LapUS, staging information in addition to that obtained from laparoscopy alone was obtained in 20 patients (53%), and changed the decision regarding tumour resectability in 10 patients (25%). Laparoscopy with LapUS was more sensitive and accurate than laparoscopy alone in identifying tumour unresesctability (88% and 89% versus 50% and 65%). Study 3 comprised a prospective 'blind' comparison of USS, CT, laparoscopy with LapUS and selective visceral angiography (SVA) in the TNM staging of fifty patients with pancreatic or periampullary cancer. The unique role of staging laparoscopy in the detection of intraabdominal metastatic disease was verified by its significantly superior sensitivity and negative predictive value compared with USS and CT. In the evaluation of T stage, laparoscopy with LapUS was significantly less likely to overstage tumour compared with USS or CT. Reliable determination of N stage was not achieved by any investigation. When all these factors were considered, laparoscopy with LapUS was shown to be superior to other investigations in identifying tumour resectability, and significantly more reliable than CT in determining tumour unresectability.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:653023 |
| Date | January 1997 |
| Creators | John, Timothy G. |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/21329 |
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