Carbohydrate antigen 19·9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Laparoscopy with laparoscopic ultrasonography (L–LUS) may be useful in the selection of patients for surgery to resect peripancreatic malignancy in addition to contrast-enhanced computed tomography (CE–CT). The present prospective study assessed the strategy of using carbohydrate antigen 19·9 (CA19·9) levels to select patients for L–LUS.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients with suspected peripancreatic malignancy that appeared resectable on CE–CT were selected for immediate surgery if CA19·9 was low (up to 150 kU/l, or up to 300 kU/l if serum bilirubin was above 35 µmol/l), or to L–LUS if CA19·9 was high (over 150 kU/l, or over 300 kU/l if serum bilirubin was above 35 µmol/l). Data were assessed to determine the clinical utility of this strategy.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 94 patients went straight to surgery, of whom 65 proved resectable: 63 of 80 with a low CA19·9 level but only two of 14 with a high CA19·9 level and gastric outlet obstruction. From 55 patients with high CA19·9 levels, L–LUS correctly identified 26 of 31 resectable tumours and eight of 24 unresectable tumours.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Using CA19·9 levels to help select patients with pancreatic malignancy for immediate surgery or L–LUS for further assessment of resectability effectively increased resection rates and reduced unnecessary laparotomies.</jats:p> </jats:sec>