Background: Unnecessary laparotomy in patients with advanced pancreatic cancer may both compromise
the quality of life and delay the initiation of more appropriate therapy. Very often, peritoneal
small liver metastases and true local status cannot be fully determined without surgery. Laparoscopy
may spare laparotomy and decrease morbidity for patients with nonresectable advanced
disease. The aim of this study was to determine the impact of laparoscopy in patients with potentially
resectable adenocarcinoma of the pancreas.
Materials and Methods: We reviewed the records of patients undergoing pancreatic surgery at the
University of Nebraska Medical Center from October 2001 to April 2005. A total of 59 patients were
included in the study. All patients were staged radiographically with a high resolution helical computed
tomography scan and their tumors were considered resectable. Thirty-seven patients underwent
staging laparoscopy while 22 proceeded directly to laparotomy.
Results: Of the 37 patients who underwent laparoscopic staging, 9 (24.3%) were detected to have
metastatic disease or advanced tumor; the remaining 28 (75.7%) patients with negative laparoscopy
proceeded to laparotomy. Of those, 24 patients (85.7%) underwent pancreatic resection with curative
intent, while 4 patients had metastatic or locally advanced disease at subsequent laparotomy
which was missed on staging laparoscopy (false negative rate of 14.3%). Of the 22 patients who proceeded
directly to laparotomy, 16 (72.7%) received curative Whipple resection and 6 (27.3%) were
found to have advanced disease and received bypass procedures or biopsy alone.
Conclusion: These findings suggest that staging laparoscopy is beneficial in a significant proportion
of patients deemed resectable by routine noninvasive preoperative studies. We plan to add intraoperative
laparoscopic ultrasound to our staging protocol in order to decrease the false negative
rate.
