Laparoscopy in the staging of pancreatic cancer

Background: Over the past decade, laparoscopy has emerged as a popular meth od of detecting extrapancreatic metastatic disease in patients presumed to have localized pancreatic cancer. Methods and results: The English language literature on laparoscopic stagin g of pancreatic cancer was reviewed. Interpretation of this literature on s taging laparoscopy is difficult because (1) there has been inconsistent use of high-quality computed tomography (CT) in prospective studies, (2) many studies have included patients with locally advanced disease, and (3) the R -0/R-1/R-2 resection rates among patients staged by laparoscopy have not be en reported, making it impossible to correlate laparoscopic findings with t he R-0 resection rate. Laparoscopy may prevent unnecessary laparotomy in a proportion of CT-staged patients presumed to have resectable pancreatic can cer. However, routine laparoscopy is performed on patients judged to have r esectable disease by high-quality CT, this fraction of patients is between 4 and 13 per cent. Conclusion: When state-of-the-art CT is available, the routine use of stagi ng laparoscopy may not be easily justified from the data in the recent lite rature. Selective use of laparoscopy may be more appropriate and will proba bly be a more cost-effective staging approach. Criteria are presented for t he selective use of laparoscopy in the staging of patients with localized p ancreatic cancer.