The role of laparoscopy in advanced pancreatic cancer diagnosis.
OBJECTIVE
Histological diagnosis between ductal and endocrine carcinoma is imperative in patients with advanced and unresectable pancreatic malignancies because of the different treatment modalities and prognoses. Whenever percutaneous and endoscopic ultrasound-guided pancreatic fine needle aspiration (FNA) fails to obtain a diagnostic specimen, a laparoscopic approach may be employed.


METHODS
Between October 2002 and July 2004, 19 patients with demonstrated unresectable pancreatic cancer underwent laparoscopy to obtain a cytohistological diagnosis.


RESULTS
The mean operative time was 83 min. Laparoscopy showed the presence of liver metastases in 15 patients that were correctly diagnosed by preoperative imaging in only 8 cases (53%). Overall 5 pancreatic FNA and 16 liver and peritoneal biopsies were obtained. In 1 patient the procedure was abandoned due to hypercapnia. In 16 patients (84%) a cytohistological diagnosis was obtained. There were no mortalities.


CONCLUSIONS
Laparoscopic biopsy of advanced unresectable pancreatic cancer is a feasible, safe and reliable procedure to obtain a cytohistological diagnosis whenever ultrasound-guided FNA fails.
Butturini
Giovanni
G
Surgical and Gastroenterological Department, University of Verona, Policlinico GB Rossi, Verona, Italy. giovanni.butturini@univr.it
Crippa
Stefano
S
Bassi
Claudio
C
Salvia
Roberto
R
Piccoli
Micaela
M
Pederzoli
Paolo
P
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007327:Insufflation; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery