Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography

• Published in: Surgical endoscopy Vol. 19; no. 5; pp. 638 - 642
• Main Authors: LIU, R. C, TRAVERSE, L. W
• Format: Conference Proceeding Journal Article
• Language: English
• Published: New York, NY Springer 01.05.2005; Springer Nature B.V
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Digestive system. Abdomen; Endoscopy; False Negative Reactions; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - methods; Laparoscopy - statistics & numerical data; Liver Neoplasms - diagnosis; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging - methods; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Peritoneal Cavity - cytology; Peritoneal Neoplasms - diagnosis; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - secondary; Sensitivity and Specificity; Therapeutic Irrigation; Tomography, Spiral Computed; Tumors; Adenocarcinoma; Radiodiagnosis; Staging; Cytology; Laparoscopy; Malignant tumor; Neoplasm; Pancreas cancer; Digestive diseases; Medical imagery; Computerized axial tomography; Diagnosis; Endoscopy; Pancreas; Pancreatic disease
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-004-8165-x

Computed tomography (CT) is insensitive to small metastatic deposits in patients with pancreatic cancer. This study aimed to evaluate additional staging information obtained by laparoscopy in the subset of patients with locally extending pancreatic cancer but no evidence of distant disease using computed tomography. Between April 2000 and February 2004, 74 patients with locally unresectable pancreatic cancer and no evidence of metastasis detected by high-quality pancreas protocol computed tomography underwent outpatient staging laparoscopy and peritoneal lavage cytology. Occult tumor was found during staging laparoscopy in 25 of the 74 patients (34%). The results were positive for peritoneal lavage cytology in 27% (20/74), for liver lesions in 16% (12/74), and for peritoneal implants in 7% (5/74) of the patients. Body and tail tumors were twice as likely as pancreatic head tumors to have unsuspected metastasis (53% vs 28%). Even the best computed tomography scan is not adequate for accurate staging of locally extended pancreatic cancer because occult distant disease will be found in half of the patients with left-sided disease and one-fourth of those with right-sided pancreatic cancer.