LESSER SAC ENDOSCOPY AND LAPAROSCOPY IN PANCREATIC-CARCINOMA DEFINITIVE DIAGNOSIS, STAGING AND PALLIATION

Laparoscopy with lesser sac endoscopy (LSE) were used in combination f rom 1987 to 1992 in 103 patients for differentiation between pancreati c carcinoma and other peripancreatic pathology, staging, and palliatio n. LSE identified pancreatic carcinoma in 38 patients; pancreatic cyst adenocarcinoma in 2 patients; pancreatic cystadenoma in 3 patients; pa ncreatic adenoma in 1 patient; pancreatic metastases from liver in 2 p atients; and pancreatic cysts in 5 patients. False negative diagnosis of pancreatic carcinoma occurred in two cases. Nontumor pancreatic pat hology was revealed in 10 patients. Specifically, acute pancreatitis w as found in four patients, and chronic pancreatitis was found in six p atients. Extrapancreatic cancers were identified in 15 patients: retro peritoneal extraorgan tumors were found in 2 patients; extrahepatic bi liary tract cancer in 6 patients; gallbladder cancer in 1 patient; liv er canter in 3 patients; and stomach cancer in I patient. In five case s no pathology was found. Overall correct definitive diagnosis was est ablished in 101 patients. Sensitivity of laparoscopy with LSE for panc reatic carcinoma diagnosis proved to be 95 per cent (38 of 40 patients ), for pancreatic tumors diagnosis 96.22 per cent (51 of 53 patients); specificity of the method 100 per cent; and accuracy of diagnosis 98 per cent (101 of 103 patients). Thus, the accuracy of the method was a s high as the accuracy of combination of all known modalities. Criteri a of unresectability were revealed with the combination of LSE and lap aroscopy in 75 per tent (30 of 40 cases) of pancreatic carcinoma. More over, laparoscopy allowed palliation of pancreatic carcinoma. Laparosc opic cholecystostomy was performed in 10 patients,and laparoscopic cho lecystojejunostomy with enteroenterostomy was performed in 6 patients.