title: Advanced staging laparoscopy using single-incision approach for unresectable pancreatic cancer.
abstract: OBJECTIVE
  As laparoscopy can detect imaging-occult metastatic lesions, it has been validated as a means of improving the assessment of tumor staging. Although controversy exists as to whether the procedure should be used routinely or selectively in pancreatic cancer patients, patients considered for treatment protocols for locally unresectable pancreatic cancer should be staged laparoscopically before initiation of therapy. We evaluate the feasibility and safety of advanced staging laparoscopy including peritoneal lavage cytology, laparoscopic ultrasound sonography (LUS), and LUS-guided biopsy through a single incision for locally advanced pancreatic cancer.
  
  
  METHODS
  Staging laparoscopy was performed in 44 patients with pancreatic cancer for deciding on treatment strategy. Our procedures included extensive peritoneal lavage of abdominal cavity for cytology, LUS for small metastasis detection, and tissue sample excision including LUS-guided biopsy. Eleven consecutive patients were treated with a single-incision staging laparoscopy approach (SI-SL group). The clinical parameters were compared between the SI-SL group and the multi-incision staging laparoscopy group (multi-incision group).
  
  
  RESULTS
  The mean operating time was longer and bleeding volume was less in the SI-SL group, although the differences were without statistical significance. The conversion rates to laparotomy were 9% in the SI-SL group and 30% in the multi-incision group. There were no severe postoperative complications. LUS-guided biopsy revealed malignancy for 3 patients in the SI-SL group.
  
  
  CONCLUSIONS
  Advanced SI-SL is a feasible and safe alternative to the multi-incision approach for pancreatic cancer.
authors.affiliation: Department of Surgical Oncology and Digestive Surgery, Field of Oncology Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. kmaemura@m3.kufm.kagoshima-u.ac.jp
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mataki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurahara
authors.forename: Tomomi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Taisaku
authors.initials: T
authors.lastname: Kuwahata
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sakoda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Sonshin
authors.initials: S
authors.lastname: Takao
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D018084:Ultrasonography, Interventional