Diagnosis and staging of pancreatic cancer: Laparoscopy

Identifying patients with localized pancreatic ductal adenocarcinoma (PDAC) remains a challenge, partly due to difficulties in detecting small lung, peritoneal, and liver metastases. Even in the era of high-quality CT imaging, a minority of patients with resectable tumors based on preoperative workup are found to have occult intra-abdominal metastases at the time of planned surgical resection. Staging laparoscopy prior to laparotomy in PDAC patients has been shown to be a safe and effective strategy to decrease the number of patients who undergo nontherapeutic laparotomies. Patients with elevated preoperative CA 19-9 or locally advanced tumors may particularly benefit from this algorithm. Through avoidance of unnecessary laparotomy, patients have shorter inpatient stays, faster recoveries, and are able to begin or immediately resume treatment with chemotherapy. Thus, staging laparoscopy has an impactful role in the modern treatment of pancreatic cancer.