[Contribution of laparoscopic echography in the staging of curative resection of cancer of the pancreatic head (26 cases)].
In a prospective study, 26 patients with pancreatic and peri-ampullary cancer were evaluated with ultrasound (US), computerized tomography (CT Scan), endoscopic ultra sonography (EUS) and laparoscopic ultrasound (LUS). Sensitivity of US and CT scan were comparable, although CT scan seems better to evaluate the size of the tumor and for lymph node detection. 50 per cent of patients had a criterion for noncurative resection. EUS (16 cases) had the best sensitivity (100 per cent) for the staging of small tumors (less than 20 millimeters), detection of adjacent nodes and the relation between tumor and mesenteric and portal veins. EUS was not able to detect peritoneal and/or liver micro-metastases (44 per cent of them would be missed by this examination alone). The criterion for noncurative resection was 56.6 per cent. LUS exactly assessed all tumors larger than 3 centimeters (100 per cent). The accuracy compared with endoscopic ultra-sonography was not as good for small tumors and adjacent nodes, was equal for the venous relations with tumors, but better concerning micro-peritoneal or hepatic metastasis. The criterion for noncurative resection was 80 per cent. These results suggest to use of US and CT as first-line procedures in the pre-operative staging and assessment of resectability of pancreatic cancers. When the patient does not appear to have disseminated lesions (50 per cent), endoscopic ultra-sonography gives a good estimation of the size of the tumor, node assessment and vascular relations. LES could be the first step for a curative surgical treatment LES revealed to discover 15 to 30 per cent of unknown micrometastases and avoided useless laparotomy in these patients.