Anand, L (2009) Does staging laparoscopy avoid non-therapeutic laparotomies in extrahepatic biliary and periampullary carcinoma. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Hepatobiliary pancreatic malignancies form a major part of gastrointestinal surgical practice. Apart from hepatic and pancreatic malignancies the incidence of bile duct tumours constitute about 2% of all reported cancers.It is an uncommon cancer with an incidence of 1-2 per 100,000 in United states the advent of new diagnostic methods applicable in obstructive jaundice has led to the pre operative discovery of many more of these lesions ,which almost certainly were misdiagnosed in the past .Most patients are older than 65 years of age and the peak incidence occurs in the 70’s • 40-60% of cholangiocarcinoma develop at the hilum • 20-30% arise in the distal lower biliary tract • <10% arise intrahepatically . Cancer of the gall bladder is the most common biliary malignancy and is the Fifth most common gastrointestinal cancer . In the United states it has an incidence of approximately 1.2 per 1,00,000 and is the cause of about 2800 deaths yearly. Owing to its aggressive nature (manifested by The propensity toward nodal metastases ,direct hepatic invasion and seeding of peritoneal surfaces,it is usually diagnosed at an advanced stage resulting in an overall medium survival of less than 6 months. Recent advances in understanding of the tumour biology accompanied by significant progress in diagnostic and surgical extirpative techniques, have motivated a fresh new approach to the universally fatal disease providing the possibility of cure to a subset of patients presenting with gall bladder cancer. Ampullary carcinoma is the second most common periampullary carcinoma With an overall incidence of 6 cases per 1 million or approximately 1800 Case per year in the United states. Although it accounts for a higher percentage of operative cases because these lesions are more amenable to complete resection. Distal bile duct carcinoma occur less frequently than pancreas and ampullary carcinoma. Pathological examinations of resected pancreaticoduodenctomy specimen reveal that approximately 40-60% are performed for adenocarcinoma of the pancreas,10-20% are performed for adenocarcinoma of the ampulla, 10% are performed for bileduct adenocarcinoma. 5-10% are performed for duodenal adenocarcinoma. OBJECTIVES : To evaluate if: 1. Staging laparoscopy avoids non-therapeutic laparotomies in extra hepatic biliary and periampullary carcinoma. 2. Is it worthwhile to do it as a routine for all cases or be selective in offering staging laparoscopy to reduce the health care costs? JUSTIFICATION : 1. The value of diagnostic staging laparoscopy in pancreatic cancers i.e. the yield has gone to >30% in some studies and hence its use is already established in the staging workup 9,10. 2. Laparoscopy has been noted to be useful on assessing primary heptocellular carcinoma 11. 3. For other less common cancer such as duodenal carcinoma ,ampullary carcinoma ,distal cholangiocarcinoma controversy exists as to the yield of detecting metastatic disease,which is much lower 12. 4. Some authors have argued that the yield of staging laparoscopy is sufficiently low in patients with radiologically resectable tumors.They also claim that with modern imaging,this test need not be performed routinely and a more selective approach is appropriate 13,14,15,16. 5. This subject has brought in lot of controversies in various HPB units across the globe . Also there is not much evidence in literature regarding this subject.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | staging laparoscopy ; non-therapeutic laparotomies ; extrahepatic biliary ; periampullary carcinoma. |
| Subjects: | MEDICAL > Surgical Gastroenterology and Proctology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 27 Jul 2017 03:40 |
| Last Modified: | 27 Jul 2017 03:40 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2213 |
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