Minimal access surgery is widely practiced, however, few prospective studies have rigorously analyzed this technique. Uncontrolled studies have reported benefits of minimal access surgery for staging, and for treatment of various GI and thoracic malignancies. Pancreatic cancers are usually advanced at presentation, accurate preoperative staging of pancreatic cancer may amongst other things: (1) prevent unnecessary open surgical procedures for unresectable disease, (2) provide better preoperative staging for patients in clinical trials, particularly in trials with neoadjuvant chemoradiation, (3) accurate staging is essential if palliative surgical procedures are considered by laparoscopically assisted surgery. The first major long-term goal of this proposal would be to establish whether staging pancreatic cancers by laparoscopy will correlate with findings at open surgery and improve resectability rates of patients coming to open surgery. Anecdotal reports have documented the feasibility of palliative procedures for pancreatic cancers by minimal access surgical techniques. The second long term goal of this proposal is to assess in a controlled Phase II trial whether comprehensive surgical management of unresectable pancreatic cancer is feasible and safe using laparoscopically assisted surgery. If our results are positive then in the second half of the study period we would be interested in conducting Phase III trials. The research methodology will incorporate standard surgical techniques of minimal access surgery. A new laparoscopic ultrasound probe will be evaluated for staging the tumors. Findings of laparoscopic staging procedures will be correlated with those at open surgery. Palliative laparoscopically assisted procedures will be compared to our retrospective experience with similar open procedures. The findings from the present proposal may substantially change the way pancreatic cancers are investigated preoperatively and managed surgically.
| Wren, S M; Ralls, P W; Stain, S C et al. (1996) Assessment of resectability of pancreatic head and periampullary tumors by color flow Doppler sonography. Arch Surg 131:812-7;discussion 817-8 |
