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Routine diagnostic laparoscopy is unnecessary in staging tumors of the pancreatic head
1Section of Surgical Oncology, Wilford Hall USAF Medical Center, San Antonio, Tex 78236, USA.
Background:
This study examined the success of computed tomography (CT) and angiography in predicting resectability of tumors of the pancreatic head and retrospectively examined whether diagnostic laparoscopy would have contributed additional staging information.
Methods:
The records of 67 patients with tumors of the pancreatic head were reviewed. Thirty-four patients had unresectable tumors, and 33 had tumors that were considered operable according to CT and angiographic findings.
Results:
Surgical resection was successful in 27 of 33 patients (82%). Surgical resection was abandoned in 6 cases due to inability to develop a plane behind the pancreatic head in 4 cases, peritoneal implants in 1 case, and an occult hepatic metastasis in 1 case. Diagnostic laparoscopy might have detected metastases in the latter two cases. Thus, in retrospect, diagnostic laparoscopy might have altered management in only 2 of 33 surgical cases (7%).
Conclusions:
The potentially limited usefulness of diagnostic laparoscopy in this series, in retrospect, raises the question of whether routinely using diagnostic laparoscopy in staging tumors of the pancreatic head is cost effective.