Laparoscopy in pancreatic and hepatobiliary cancer

Laparoscopic techniques can be used for diagnosis, staging, and therapeutic procedures, both palliative or curative. Laparoscopy needs to be used in the context of algorithms of evaluation and management that consider the natural history and biology of the diseases at stake, concepts of evidence-based decisions, cost-effectiveness, quality of life, expertise available, and the philosophy of involved institutions. Accurate staging facilitates the selection of patients for resection, for neoadjuvant therapy, and selective planning for best palliation. The therapeutic role of advanced laparoscopic or laparoscopic assisted procedures is likely to increase (biliary bypass, gastro-jejunostomy, liver resections, cryosurgery, radiofrequency ablation, etc.). The place of laparoscopy in staging and treatment, however, has to be critically and continuously reviewed in the context of new developments in diagnostic imaging techniques, endoscopic procedures, and advances in oncology.