DIAGNOSTIC LAPAROSCOPY COMBINED WITH LAPAROSCOPIC ULTRASONOGRAPHY IN STAGING OF CANCER OF THE PANCREATIC HEAD REGION

The aim of this study was to assess the additional role of diagnostic laparoscopy combined with laparoscopic ultrasonography in the staging of patients with pancreatic head malignancy. Between January 1993 and June 1994, 73 patients with stage I cancer of the pancreatic head dete rmined by preoperative investigation (endoscopic retrograde cholangiop ancreatography and Doppler ultrasonography) were eligible for laparosc opic ultrasonography. The peritoneal cavity was investigated for perit oneal deposits, intrahepatic metastases, malignant infiltration of the portal and superior mesenteric vessels, and N-3 lymph node metastases . All patients without histologically proven metastases proceeded to l aparotomy. Seventy patients were eligible for evaluation. Sixteen of t he 21 patients with distant metastases were diagnosed by laparoscopy w ith ultrasonography. Forty-nine patients had surgical exploration and trial dissection to assess local resectability. Twenty-nine patients ( 41 per cent) had resectable pancreatic head tumours. The positive pred ictive value of local ingrowth as determined by laparoscopic sonograph y was 93 per cent. Laparotomy was avoided in 19 per cent of patients a nd the preoperative stage was changed in 41 per cent. Laparoscopy incl uding ultrasonography was effective in staging pancreatic head maligna ncy.