Serum CA19-9 measurement increases the effectiveness of staging laparoscopy in patients with suspected pancreatic malignancy

Background/ Aims: Staging laparoscopy for suspected pancreatic neoplasia is not widely accepted due to its low yield. The aim of this study was to determine if serum carbohydrate antigen ( CA19- 9) levels could be used to improve the selection of patients for staging laparoscopy. Methods: The data from a prospectively collected database ( 1997 - 2004) with 159 patients who had computed tomography- predicted resectable disease and who had undergone laparoscopic staging were analysed to determine if a low preoperative CA19- 9 level (<= 150 kU/ l, or <= 300 kU/ l with a bilirubin > 35 mu mol/ l) identified patients in whom laparoscopy was not useful. Results: The CA19- 9 level was 1 150 kU/ l in 96 patients of whom 75 ( 78%) were considered resectable following laparoscopic assessment. There were 63 patients with a CA19- 9 level (<= 150 kU/ l of whom 60 (95%) were considered resectable following laparoscopic assessment. The sensitivity, specificity, positive predictive value and negative predictive value for CA19- 9 <= 150 kU/ l in predicting that laparoscopic assessment would judge patients as resectable were 44, 88, 95 and 22%, respectively. A cut- off level of <= 300 kU/ l in patients with a bilirubin > 35 mu mol/ l produced values of 30, 94, 94 and 28%, respectively. By using CA19- 9 <= 150 kU/ l, laparoscopy could have been avoided in 40% of patients, increased to 55% of patients with adjustment for the presence of jaundice; concomitantly, the yield from laparoscopy would have been increased from 15 to 22 and 25%, respectively. Conclusion: Use of serum CA19- 9 levels would increase the efficiency of laparoscopic staging in patients with suspected pancreatic malignancy. Copyright (c) 2005 S. Karger AG, Basel.