OPERATIVE TECHNIQUE FOR THE LAPAROSCOPIC STAGING OF PANCREATIC MALIGNANCY

Special technique and equipment is required for staging and pre-operat ive assessment of patients with pancreatic cancer. The operative steps to explore the pancreas through an infragastric route used in 21 cons ecutive patients with pancreatic neoplasms are described in this paper . This entails the use of distally curved coaxial instruments and of e ndosurgical staplers to open the gastro-colic ligament. A wide exposur e of the pancreatic body and tail allows laparoscopic contact ultrason ography of the whole gland, Both longitudinal and transversal sections of the pancreas are obtained for the purpose of defining tumour limit s, lymph nodal involvement and possible spread to regional vessels. An alysis of preliminary results supports the view that laparoscopic asse ssment of pancreatic cancer is safe and effective in achieving the goa l of an accurate staging, Laparoscopic related information in this ser ies led to a change in diagnosis or surgical strategy in 9.5% and 38% of patients, respectively. This approach obviates exploratory laparoto my in patients not suitable for resection and carries a potential valu e in the selection of patients for future adjuvant treatments.