Role of diagnostic laparoscopy in assessing resectability of pancreatic and periampullary cancer

Abstract

Abstracts / International Journal of Surgery 9 (2011) 363–369 368s / International Journal of Surgery 9 (2011) 363–369 368 ROLE OF DIAGNOSTIC LAPAROSCOPY IN ASSESSING RESECTABILITY OF PANCREATIC AND PERIAMPULLARY CANCER Amun Kalia, K.S. Gurusamy, V. Allen, B.R. Davidson. Department of Surgery, Royal Free Campus UCL Medical School, 9 Floor Royal Free Hospital, Pond Street, London. NW3 2QG Background: Surgical resection is the only curative treatment for pancreatic and periampullary cancer. A significant proportion of patients undergo unnecessary laparotomy because of understaging of these tumours. There has been no systematic review or meta-analysis assessing the role of diagnostic laparoscopy in assessing resectability (with curative intent) of pancreatic and periampullary cancer. Methods: A systematic review of studies was performed. Medline, Embase, Cochrane trials register, and Science Citation Index were searched until November 2009. Two reviewers independently identified studies and extracted data. The gold standard was histological confirmation of metastases. Quality of studies was assessed by the QUADAS tool. Metaanalysis was performed using hierarchical summary operating characteristics curve method of combining studies of diagnostic accuracy. Results: 23 studies including a total of 2973 patients were included in the meta-analysis. Most of the patients included in the studies had undergone a staging computerized tomogram (CT scan). Most of the studies performed histological confirmation of metastases before declaring that diagnostic laparoscopy was positive. Most of the studies had low risk of bias in the important aspects of methodological quality. The summary sensitivity and specificity obtained bymeta-analysis were 0.726 and 0.999, corresponding to a post-test probability of 1.00 for a positive diagnostic laparoscopy and 0.14 for a negative diagnostic laparoscopy compared to a baseline probability of 0.36. Thus diagnostic laparoscopy can decrease the probability of unresectable cancer found on laparotomy from 36% to 14%. Conclusions: Routine diagnostic laparoscopy prior to laparotomy can decrease unnecessary laparotomies. PATHOGENESIS OF CYSTIC MEDIAL DEGENERATION IN IDIOPATHIC DILATION OF THE ASCENDING AORTA A.K. Kar , S.K. Nair , M.J. Goddard . University of Cambridge, School of Clinical Medicine, Papworth Hospital, Cambridge CB3 8RE, UK; Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge CB3 8RE, UK; Histopathology, Papworth Hospital, Cambridge CB3 8RE, UK Introduction: Although there have been advances in the surgical management for idiopathic dilation of the ascending aorta, the pathogenesis is still poorly understood. We investigated the histopathological features of cystic medial necrosis or degeneration (CMD). Methods: Tissue samples from sixty patients who underwent surgery for idiopathic dilation of the ascending aorta were fixed and stained so that histopathological features of CMN could be studied using a Leica DMLB microscope. We measured quantitatively loss of medial vascular smooth muscle cells and graded the fragmentation of elastic fibres, accumulation of mucopolysaccarides and elastocalcinosis of the media. Dividing the media into inner and outer segments, we considered regional differences in the aortic wall. Results: HE Welsh Institute of Minimal Access Technology Aims: Surgical simulation is of increasing importance with the advent of working time directives and may eventually fill the gaps in surgical education that have been created. We assessed the feasibility of establishing construct validity in a novel animal tissue model for laparoscopic right hemicolectomy. Materials and Methods: Participants performed two defined sections of a laparoscopic right hemicolectomy using the model developed. The procedures were marked independently by video using the L-CAT Objective Structured Assessment of Technical Skills (OSATS). Participants scores in all domains were compared to the number of real-world lead laparoscopic operator procedures they had performed. Results: Six participants completed a total of 16 procedures. Laparoscopic experience showed a statistically significant positive correlation with performance during the exposure (p1⁄40.005) and vascular pedicle (p1⁄40.05) sections, and the total time taken to complete the task (p1⁄4<0.001). Laparoscopic experience also correlated significantly and positively with technical skill (p1⁄40.02) and less errors (p1⁄40.04). A strong positive correlation was seen in all other measures. Conclusions: This study was able to distinguish surgeons based on their real-world laparoscopic experience using a novel animal tissue right hemicolectomymodel as assessed by OSATS. Thus, the construct validity of the platform is established in this feasibility study. Animal tissue models