Laparoscopische stadiëring bij patiënten met een periampullaire tumor: beperkte waarde voor de diagnostiek en de eventuele palliatieve behandeling

To test the hypothesis that laparoscopic staging in addition to standard radiology staging, improves outcome in patients with peripancreatic carcinoma. To determine if, after laparoscopic staging in patients with irresectable tumours, the hospital-free survival is higher after randomization for endoscopic stent palliation than after surgical palliation.

Design

Prospective, randomized trial.

Method

In two teaching hospitals laparoscopy and laparoscopic ultrasound were performed on a series of 297 consecutive patients with peripancreatic carcinoma who were scheduled for surgery after radiological staging. Patients with pathologically proven irresectable tumours were randomly allocated to either a surgical or endoscopic palliative group. All others underwent laparotomy.

Results

Laparoscopic staging detected irresectable disease in 39 patients (13; 95 confidence interval 9.3-17). At laparotomy, irresectable disease was found in another 72 patients, a detection rate for laparoscopic staging of 35 (95 confidence interval 26-44). In total, 145 of the 197 patients, classified as ‘possibly resectable’ after laparoscopic staging, underwent resection (74). Average survival in the group of 14 patients with biopsy-proven irresectable tumours randomly allocated to endoscopic palliation, was 116 days, with a mean hospital-free survival of 94 days. The corresponding figures were 192 days and 164 days in the 13 patients allocated to the surgical palliation group (p = 0.05).

Conclusion

Because of its limited success rate in detecting irresectable metastatic disease and the probable absence of any large gain by switching from surgical to endoscopic palliation, laparoscopic staging should not be performed routinely in patients with peripancreatic carcinoma.