Value of laparoscopy in the staging of pancreatic cancer

Pancreatic cancer is a devastating disease that swiftly robs patients of both quality and quantity of life. It is the fourth leading cause of cancer death in the United States. In 2003, there were 31,860 reported new cases with 31,270 deaths occurring due to lack of effective therapy. Eighty percent of patients present with either advanced local or metastatic disease. Dynamic contrast-enhanced computed tomography (CT) has become the current staging test of choice. Laparoscopic staging of pancreatic tumors with the addition of ultrasound can reveal intraparenchymal hepatic metastases, small peritoneal metastases, and critical retroperitoneal tumor-vessel relationships approaching the accuracy of open exploration to determine resectability without significantly increasing morbidity or mortality. However, given the current accuracy of high-quality CT, the routine use of diagnostic laparoscopy in pancreatic cancer is not warranted. Diagnostic laparoscopy is recommended in select patients with primary tumors greater than 4 cm, tumors in the body or tail of the pancreas, patients with equivocal findings of metastasis on CT, ascites, or clinical or laboratory findings suggesting advanced disease such as marked weight loss, hypoalbuminemia, and elevated CA 19-9.