Laparoscopy for staging in pancreatic carcinoma.

Pancreatic cancer is the gastrointestinal malignancy with the worst prognosis. At the time of diagnosis, only 15% of patients are resectable (and potentially curable), 40% have localized but unresectable tumours, and 45% distant metastases. Computerized tomography, angiography, and laparoscopy allow for adequate staging in this neoplasm. The latter is useful for identifying the small (1-2 mm) peritoneal and liver implants which, in our experience, are present in 27% of patients with tumours of the pancreatic head and in 65% of those with cancers of the body and tail of the pancreas. Peritoneal cytology may also be performed at the time of laparoscopy, and will be positive for malignant cells in 20-30% of cases indicating a bad prognosis.