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Background Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia. Aim of the study To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients. Methods All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19–9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19–9 was calculated. In jaundiced patients, a CA 19–9 adjusted for bilirubinemia was also evaluated. Results Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19–9 as a predictor of resectability was 0.886 (95%CI:[0.832–0.932]); in jaundiced patients it was 0.880 (95% CI [0.798–0.934]. A cut-off in CA 19–9 at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19–9 (r = 0.149). Conclusion Serum CA 19–9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease.

Resume La presence d’une hernie interne lors d’un bypass en omega peut etre responsable d’un chyloperitoine du fait d’une compression chronique du mesentere entrainant une extravasation de chyle pouvant mimer une peritonite.

Introduction La resection est le seul traitement a visee curative des adenocarcinomes du pancreas. Certains criteres de non resecabilite (envahissement arteriel, hepatique…) ne sont decouverts qu’au cours de l’exploration chirurgicale devant faire rechercher des marqueurs preoperatoires. L’objectif de ce travail est d’evaluer le taux serique de Ca 19.9 dans ce contexte. Methodes Une etude retrospective a inclus les patients ayant un adenocarcinome pancreatique. En cas d’ictere, le Ca 19.9 a ete ajuste en le divisant par le taux de bilirubine. Les courbes ROC ont etudie les performances du Ca 19.9. Resultats Sur 171 patients 49 (29 %) etaient resecables et 122 (71 %) ne l’etaient pas dont 58 (34 %) diagnostiques a l’imagerie preoperatoire. Un ictere etait present chez 93 patients (54 %). L’aire sous la courbe etait de 0.886 IC95 % [0,832-0,932]. Pour une valeur seuil de Ca 19.9 a 178 UI/mL, les sensibilite et specificite etaient de 85 % et 81 % avec une valeur predictive positive a 91 %. L’ajustement du C a 19.9 a la bilirubinemie n’ameliorait pas la precision du Ca 19.9 et il n’existait pas de correlation forte entre la bilirubinemie et le Ca 19.9 (coefficient de correlation r = 0.149) Conclusion Le Ca 19.9 est un marqueur predictif de resecabilite des adenocarcinomes pancreatiques meme chez les patients icteriques. Un Ca 19.9 > 178 UI/mL doit faire discuter une optimisation du bilan preoperatoire (IRM hepatique et pancreatique, coelioscopie exploratrice…). Declaration d’interet Les auteurs n’ont pas transmis de conflits d’interets.