[Significance of staging laparoscopy in pancreatic carcinoma: a case report]

Accurate staging of pancreatic malignancy is essential to properly plan appropriate therapy. The purpose of preoperative staging of intraabdominal malignancies is to identify patients in whom malignancies are unresectable and therefore would not be candidates for curative surgery. Routine preoperative evaluation of intraabdominal malignancies typically include abdominal helical computed tomographic (CT) scanning and/or ultrafast magnetic resonance (MR) imaging. In fact both investigations are considered mandatory for intraabdominal malignancies. But despite modern techniques a significant number of false negative results occur (more than 20%). This has led to the investigation of additional staging modalities to better identify patients with unresectable disease. In this purpose we present the case of a patient with pancreatic carcinoma. After preoperative imaging (ultrasound, endosonography and MRI) there was no evidence for metastatic disease (uT3uN1). He underwent laparoscopy and a hepatic lesion was detected, histologically consistent with a liver metastasis. In this patient an unnecessary laparotomy could be avoided. In conclusion laparoscopy is an important tool in the staging of intraabdominal malignancy for patients with locally advanced disease without signs of tumor spread in CT or MRT. It is a relatively simple, well-tolerated and safe procedure and decreases the rate of unnecessary laparotomies. It should be considered in all patients with pancreatic malignancy in whom laparotomy is planned, either to establish the diagnosis or before an attempt at curative resection.