RELIABILITY OF PREDICTION OF PERIAMPULLARY TUMOURS RESECTABILITY BEFORE PANCREATICODUODENECTOMY OPERATION

Aim: The aim of this study was to evaluate the accuracy of preoperative assessment in predicting surgical resectability in cases with periampullary tumours in reference to the intraoperative findings. Methods: This study included 88 cases with obstructive jaundice suspected to have potentially resectable periampullary tumours and fit for surgical exploration. These cases were subjected to biochemical laboratory investigations, idtrasonography (US), endoscopic retrograde cholangiopancreatography (ERCP), computerized tomography (CT) scan, and diagnostic laparoscopy before surgical exploration. Results: Surgical exploration revealed that 59 (67%) cases were irresectable due to portal vein(39) and coeliac trunk(5) invasions, LN infiltration,(2) liver metastasis(7) peritoneal nodtdes(3) and peripancreatic fat affection.(3) Abdominal US and ERCP were of little value in predicting resectability of such tumours. CT gave sensitivity and specificity in portal vein (97.4% 100%) and coeliac trunk (100% 100%) invasion, liver metastasis (71.4% 100%) and peritoneal nodules (33.3% 100%) respectively. Diagnostic laparoscopy coidd detect cases of small lesions of peritoneal nodules and liver metastasis that were missed on CT scanning. Although the sensitivity of detection of LN and peripancreatic fat plane affection were 100 %, their specificity were much less reliable that reached 75% 60 % respectively. Conclusion: CT revealed high accuracy residts in evaluation of periampullary tumours resectability before pancreaticoduodenectomy operations. Its accuracy is improved on using diagnostic laparoscopy before exploratory laparotomy to detect early metastasis