Laparoscopy and peritoneal cytology in the staging of pancreatic cancer

Staging laparoscopy in patients with pancreatic cancer allows identification of metastatic disease which is beyond the resolution of computed tomography. Laparoscopic ultrasound, dissection, and/or peritoneal cytology may be used to enhance the sensitivity of the staging procedure. Our experience at Massachusetts General Hospital with staging laparoscopy and peritoneal cytology over the past 8 years (N = 239) reveals that approximately 30% of patients without metastases by computed tomography harbor occult metastatic disease at laparoscopy. Additionally, published series demonstrate accurate determination of resectability in greater than 75% of patients after staging laparoscopy. Staging laparoscopy in patients with pancreatic cancer allows optimization of resources and avoidance of unnecessary surgery.