Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies.
OBJECTIVE
To determine the relative benefit of staging laparoscopy in peripancreatic and biliary malignancies.


BACKGROUND
Staging laparoscopy has been used in a variety of peripancreatic and biliary malignancies. The utility of the technique in subsets of these types of cancer has not been systematically compared.


METHODS
One hundred fifty-seven patients underwent laparoscopy after conventional tumor staging; 89 were also staged with laparoscopic ultrasonography. Diagnostic categories were cancer of the pancreatic head and uncinate process, cancer of the body and tail of pancreas, cancer of the extrahepatic bile duct, cancer of the gallbladder, and cancer of the ampulla of Vater/duodenum.


RESULTS
In patients with cancer of the head of the pancreas, metastatic disease or vascular invasion was discovered frequently by laparoscopy (31%), whereas in ampullary/duodenal cancer it was never found. The laparoscopic findings in cancer of the head of the pancreas had an important influence on treatment decisions, whereas in cancer of the ampulla/duodenum, laparoscopy had no effect on clinical decisions. Laparoscopy also substantially influenced the treatment of gallbladder cancer; in other tumor types, results were intermediate. Laparoscopic ultrasonography was valuable in cancer of the head of the pancreas.


CONCLUSIONS
The utility of staging laparoscopy depends on diagnosis. It is recommended for continued use in pancreatic head and gallbladder cancers but not in ampullary malignancies.
Vollmer
Charles M
CM
Section of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Drebin
Jeffrey A
JA
Middleton
William D
WD
Teefey
Sharlene A
SA
Linehan
David C
DC
Soper
Nathaniel J
NJ
Eagon
Christopher J
CJ
Strasberg
Steven M
SM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001706:Biopsy; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000473:pathology; D005260:Female; D005704:Gallbladder / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D014463:Ultrasonography