Laparoscopic pancreatic surgery: Indications, techniques and preliminary results

BAGKGROUND/AIMS: The purpose of this study was to evaluate feasibility, eff ectiveness and reproducibility of laparoscopy in the diagnosis and manageme nt of pancreatic diseases. METHODOLOGY: At the Second Department of Surgery of the "Regina Elena" Inst itute for Cancer Research, between June 1995 and June 1997, possibilities o f the laparoscopy in diagnosis and staging of pancreatic malignancies were studied. Twenty-four consecutive cases of pancreatic adenocarcinoma were ob served: 10 patients were pre-operatively considered unresectable and 14 cas es were submitted to a laparoscopic study. Moreover, in the period from Jan uary 1996 to June 1997, a study on the therapeutical potentialities of lapa roscopy was performed, attempting 5 pure or assisted laparoscopic pancreati c resections. RESULTS: Three cases (21.4%) out of the 14 evaluated were found to be metas tatic (liver and peritoneum); 11 patients were successfully resected with a n open standard procedure,Laparoscopy allowed a correct staging in all case s, even in the 21.4% of ultrasonography (US), TC and angiographic false neg atives. The 5 operative procedures consisted of one resect;ion of a cystade noma, one resection of a head cyst, one Wirsung lithotomy with pancreaticoj ejunostomy for Lithiasic chronic pancreatitis, and two body-tail splenopanc reatectomies (1 cystadenoma and 1 adenocarcinoma). Satisfactory early resul ts were obtained in all these cases. CONCLUSIONS: Laparoscopic diagnosis and staging of pancreatic cancer is a v aluable method which allows a very high accuracy. Pancreatic resections, ev en if feasible, are still to be considered an experimental procedure.