Operative technique for the laparoscopic staging of pancreatic malignancy

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Abstract
Special technique and equipment is required for staging and pre-operative assessment of patients with pancreatic cancer. The operative steps to explore the pancreas through an infragastric route used in 21 consecutive patients with pancreatic neoplasms are described in this paper. This entails the use of distally curved coaxial instruments and of endosurgical staplers to open the gastro-colic ligament. A wide exposure of the pancreatic body and tail allows laparoscopic contact ultrasonography of the whole gland. Both longitudinal and transversal sections of the pancreas are obtained for the purpose of defining tumour limits, lymph nodal involvement and possible spread to regional vessels. Analysis of preliminary results supports the view that laparoscopic assessment of pancreatic cancer is safe and effective in achieving the goal of an accurate staging. Laparoscopic related information in this series led to a change in diagnosis or surgical strategy in 9.5% and 38% of patients, respectively. This approach obviates exploratory laparotomy in patients not suitable for resection and carries a potential value in the selection of patients for future adjuvant treatments.