This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (38)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Surgery  • Surgical Interventions  • Endocrine Surgery  • Surgical Oncology  • Surgical Physiology  • Surgical Physiology, Other  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Michael G. Schlieman, MD; Hung S. Ho, MD; Richard J. Bold, MD

Arch Surg. 2003;138:951-956.

Hypothesis  Despite advances in preoperative radiologic imaging, a significant fraction of potentially resectable pancreatic cancers are found to be unresectable at laparotomy. We tested the hypothesis that preoperative serum levels of CA19-9 (cancer antigen) and carcinoembryonic antigen will identify patients with unresectable pancreatic cancer despite radiologic staging demonstrating resectable disease.

Design and Setting  Academic tertiary care referral center.

Patients  From March 1, 1996, to July 31, 2002, 125 patients were identified who underwent surgical exploration for potentially resectable pancreatic cancer based on a preoperative computed tomographic scan; in 89 of them a preoperative tumor marker had been measured.

Main Outcome Measures  Preoperative tumor markers (CA19-9 and carcinoembryonic antigen) were correlated with extent of disease at exploration. As CA19-9 is excreted in the biliary system, CA19-9 adjusted for the degree of hyperbilirubinemia was determined and analyzed.

Results  Of the 89 patients, 40 (45%) had localized disease and underwent resection, 25 (28%) had locally advanced (unresectable) disease, and 24 (27%) had metastatic disease. The mean adjusted CA19-9 level was significantly lower in those with localized disease than those with locally advanced (63 vs 592; P = .003) or metastatic (63 vs 1387; P<.001) disease. When a threshold adjusted CA19-9 level of 150 was used, the positive predictive value for determination of unresectable disease was 88%. Carcinoembryonic antigen level was not correlated with extent of disease.

Conclusions  Among the patients with resectable pancreatic cancer based on preoperative imaging studies, those with abnormally high serum levels of CA19-9 may have unresectable disease. These patients may benefit from additional staging modalities such as diagnostic laparoscopy to avoid unnecessary laparotomy.

From the Department of Surgery, Divisions of Surgical Oncology (Drs Schlieman and Bold) and Gastrointestinal Surgery (Dr Ho), UC Davis Cancer Center, Sacramento, Calif.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Significance of the Depth of Portal Vein Wall Invasion After Curative Resection for Pancreatic Adenocarcinoma
Fukuda et al.
Arch Surg 2007;142:172-179.
ABSTRACT | FULL TEXT  

Perioperative CA19-9 Levels Can Predict Stage and Survival in Patients With Resectable Pancreatic Adenocarcinoma
Ferrone et al.
JCO 2006;24:2897-2902.
ABSTRACT | FULL TEXT  

The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review
Stefanidis et al.
Ann Oncol 2006;17:189-199.
ABSTRACT | FULL TEXT