Peritoneal metastases in pancreatic carcinoma

Peritoneal metastases are present in about 50% of patients with pancreatic cancer at the time of death, and are the second most common site of involvement, following the liver. The small size of peritoneal metastases precludes their identification by CT scan, and thus they have to be identified by direct visualization, either at laparotomy or through laparoscopy. Adding laparoscopy to the staging protocol permits pre-operative identification of patients who will not benefit from surgery. Malignant cells are also found within the peritoneal cavity in 20 to 30% of patients with pancreatic cancer who otherwise have no peritoneal or liver metastases. Their presence, documented by peritoneal washings during laparoscopy or at the time of surgery, seems to be associated with an adverse prognosis.