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


METHODS
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.


RESULTS
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%).


CONCLUSIONS
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.
Liu
R C
RC
Section of General, Vascular, and Thoracic Surgery, Virginia Mason Medical Center, 1100 Ninth Avenue, C6-GSurg, 900, Seattle, WA 98111, USA.
Traverso
L W
LW
D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D010529:Peritoneal Cavity / Q000166:cytology; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary*; D012680:Sensitivity and Specificity; D007507:Therapeutic Irrigation; D036542:Tomography, Spiral Computed