Résumé
Le bilan préopératoire de l’adénocarcinome du pancréas doit sélectionner précisément les malades susceptibles de bénéficier d’une pancréatectomie. L’échographie percutanée et la TDM spiralée doivent être réalisées en premier pour la détection des métastases hépatiques et péritonéales. L’échoendoscopie est importante pour détecter et si possible prouver histologiquement l’envahissement ganglionnaire à distance et l’envahissement des artères digestives qui contre-indiquent une pancréatectomie, et pour détecter ou évaluer l’importance de l’envahissement veineux mésentérico-porte qui autorise une pancréatectomie dans certains cas. De plus, l’EE permet de prouver histologiquement — avant exérèse à visée curative — les tumeurs de présentation atypique et les tumeurs dont l’extirpabilité est incertaine. L’exploration laparoscopique, y compris avec écholaparoscopie, n’apparaît pas susceptible de modifier les données sur l’extension loco-régionale fournies par l’échoendoscopie.
Summary
For pancreatic adenocarcinoma, preoperative staging must select accurately candidates for a curative pancreatectomy. Percutaneous ultrasound and spiral CT scan must be performed at first for detection of peritoneal and hepatic metastases. Endoscopic ultrasound is important for detection, and if possible histological proof, of arterial involvement and remote lymph node metastases contraindicating curative pancreatectomy, and for detection or precise evaluation of mesentericoportal venous involvement which allows pancreatectomy with venous reconstruction in selected cases. Furthermore, endoscopic ultrasound can obtain histological proof before curative resection for tumours with unusual presentation or uncertain resectability. Laparoscopic exploration, even with laparoscopic ultrasound, does not seem able to modify assessment of locoregional involvement given by endoscopic ultrasound.
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Sauvanet, A. Cancer du pancréas: qu’attend le chirurgien de l’échoendoscopie?. Acta Endosc 31, 57–61 (2001). https://doi.org/10.1007/BF03023652
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DOI: https://doi.org/10.1007/BF03023652