Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer.

A total of 114 patients with pancreatic cancer and no evidence of metastatic disease by computed tomography underwent laparoscopy. Intra-abdominal spread was present in 27 patients (24 per cent). Metastases were 2.4 times more common in tumours of the distal pancreas (11 of 25, 44 per cent) than in pancreatic head tumours (16 of 89, 18 per cent) (P < 0.05). None of the 27 patients with metastases underwent further surgery. Of the 87 patients without metastatic spread, 42 were found to have vascular invasion by angiography and were offered radiation therapy. Thirty of 40 patients explored surgically were resected; two of the remaining ten had peritoneal spread that had been missed at laparoscopy (false-negative rate of 7 per cent). Cytological examination of peritoneal washings was performed in 94 patients at the time of laparoscopy; cytology was positive in 16 (17 per cent). There was a significant correlation between positive cytology and presence of visible liver or peritoneal metastases (ten of 22 with metastases versus six of 72 without, P < 0.001). Positive cytology was present in six patients (8 per cent) without visible metastases, but none had resectable disease.