Experience with staging laparoscopy in pancreatic malignancy

Background: The role of diagnostic laparoscopy in the staging of abdominal malignancies is not well defined. Methods: We retrospectively reviewed the usefulness of diagnostic laparosco py as a staging procedure in pancreatic malignancy. This experience between February 1988 and May 1997 involves 109 cases of suspected or proven pancr eatic malignancy. All laparoscopies were performed with the patient under c onscious sedation and local anesthesia in an endoscopy suite. Results: Of the 109 patients with pancreatic cancer, 45 (42%) had metastati c disease. The use of computed tomography (CT) alone revealed the existence of liver metastases in 10 of 109 (9%) patients, which were confirmed lapar oscopically. The further use of laparoscopy identified metastases in 29 mor e cases: hepatic, 23; hepatic and peritoneal, 3; peritoneal and mesenteric, 1; and mesenteric, 2. CT in conjunction with laparoscopy therefore reveale d metastatic liver, peritoneal, or mesenteric lesions in 39 of 109 (36%) pa tients with pancreatic cancer. After staging laparoscopy, 67 of 69 patients underwent laparotomy. Metastatic disease was identified at laparotomy in 6 more patients; however, only 4 of these patients had metastases to the liv er whereas 2 had metastases to the peripancreatic lymph nodes. Therefore, i n patients with pancreatic malignancy, the negative predictive value for th e diagnosis of metastases to the liver, peritoneum or mesentery was 94% (61 of 65 patients). The positive predictive value of laparoscopy alone for th e detection of metastatic disease to the liver, peritoneum, or mesentery wa s 88% (29 of 33 patients). Laparoscopy was successfully performed without c omplications in all patients with pancreatic cancer; however, one had a tec hnically unsatisfactory examination. The overall rate of resectability afte r staging by imaging studies and laparoscopy was 57% (35 of 61 patients). Conclusions: In patients with a negative CT for metastases, laparoscopic id entification of metastases avoided unnecessary laparotomy in 29 of 99 (29%) patients with pancreatic cancer. Staging laparoscopy is indicated in all c ases of pancreatic malignancy before an attempt at a surgical cure.