Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate

Staging laparoscopy, based on the assumption that endobiliary stenting is t he best palliation, allegedly saves an "unnecessary" laparotomy for incurab le pancreatic cancer. Our aim was to determine survival of patients with cl inically resectable pancreatic cancer that is found to be unresectable intr aoperatively and thereby infer appropriate utilization of staging laparosco py. A retrospective analysis was undertaken of 148 patients with ductal ade nocarcinoma (1985 to 1992) with a clinically resectable lesion based on cur rent imaging techniques. All were considered candidates for resection but w ere deemed unresectable at operation because of metastases to the liver (gr oup I; 29 patients), the peritoneum (group II; 22 patients), or distant lym ph nodes (group III; 44 patients) or because of vascular invasion (group TV ; 53 patients). Overall median survival was 9 months (range 1 to 53 months) , but by group was as follows: group I, 6 months; group II, 7 months; group III, 11 months; and group TV, 11 months. Individual comparisons showed sho rter survival for patients with distant nodal, liver, or peritoneal metasta ses than with nodal or vascular involvement (P <0.03). Staging laparoscopy should be performed to identify patients with liver or peritoneal metastase s who have an expected survival of approximately 6 months, in whom short-te rm endoscopic palliation is satisfactory. Extended laparoscopy to identify lymph node or vascular involvement is contingent upon which palliation (ope rative vs. endoscopic) is considered most appropriate. Because we believe o perative bypass provides better, more durable palliation in this latter gro up, we have not adopted extended laparoscopy.