title: Staging laparoscopy and its indications in pancreatic cancer patients.
abstract: BACKGROUND
  Laparoscopy has become a popular and widespread surgical technique. An important goal in the treatment of patients with pancreatic cancer is to avoid any unnecessary procedure. Laparoscopy has been suggested as a routine tool for staging in order to prevent unnecessary laparotomies in these patients.
  
  
  METHODS
  In this article we present our experience regarding the value of laparoscopic staging and review the literature on this topic.
  
  
  CONCLUSIONS
  A direct and conclusive comparison of the controversial literature is difficult because of different study designs. Inconsistent use of high-quality CT scans significantly affects the results. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a state-of-the-art CT scan has been performed previously. Therefore, we conclude that routine diagnostic laparoscopy is not justified in all patients with pancreatic cancer. Rather, selective use is appropriate, especially in patients in whom ascites is an indirect sign of peritoneal metastases, or if liver metastases cannot be surely excluded preoperatively. This approach is cost-effective and limits diagnostic laparoscopy to a subgroup of patients in whom a laparotomy can be avoided.
authors.affiliation: Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Hennig
authors.forename: Adrien A
authors.initials: AA
authors.lastname: Tempia-Caliera
authors.forename: Marc
authors.initials: M
authors.lastname: Hartel
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D014057:Tomography, X-Ray Computed