Examination of Staging Laparoscopy for Advanced Pancreatic Cancer

Yuko Mataki, PhD, Kosei Maemura, Hiroshi Kurahara, Yota Kawasaki, Keiichi Yonemori, Masahiko Sakoda, Satoshi Iino, Koji Minami, Shinichi Ueno, Hiroyuki Shinchi, Shoji Natsugoe. Kagoshima University

Introduction: In advanced pancreatic cancer, it is very important to perform an accurate diagnose such as peritoneal disseminations liver metastasis for selection of an appropriate treatment. In this report, the advanced pancreatic cancer who underwent laparoscopic examination at our department were retrospectively analyzed.

Cases: the 82 cases of examination laparoscopic cases for advanced pancreatic cancer, which was performed between 2005 and 2015. In all cases, malignancy was pathologically identified by FNA under EUS, tissue biopsy by laparoscopic findings or ERCP. Gender was 50 male and 32 female, average age 65 year(41-83), tumor location is pancreatic head for 57, pancreatic body 23, pancreatic tail two cases. According to TNM classification, stage III is 66 cases, IV is 16 cases, performance status 0 is in 71 cases, 1 was in 11.

Method: Preoperative imaging diagnosis were performed by MDCT, EOB-MR, abdominal US and FDG-PET, those were compared with laparoscopic findings

Result:
1. Patients without distant metastasis at the preoperative diagnosis has had 70 cases. Among them, distant metastasis were pointed out in eight cases by staging laparoscopy. PER (+) is in seven cases (one example only cytology), HEP (+) was in one example. Those location of main tumor was pancreatic head in three cases, pancreatic body in five cases.
2. In the preoperative image, HEP (+) is in eight cases, PER (+) is in three cases, both HEP (+) and PER (+) but was in one case. In the examination of laparoscope, HEP (+) was detected among the eight cases, HEP + is four cases, PER + is three cases, remaining one example HEP, PER were both negative. PER (+) in 3 patients had all histologically PER (+).
3. The resection of liver metastasis and peritoneal dissemination were underwent by staging laparoscopy (including small laparotomy) in 13 cases, and biopsy of the primary lesion was underwent in 27 cases. Although admitted pancreatic fistula of Grade B in one cases, there were no other complications.

Conclusions:
By laparoscopic examination in advanced pancreatic cancer who had preoperatively no detection of distant metastasis, we could detect the distant metastases in about 10%, Moreover, we can collect some tissue of the distant metastasis, staging laparoscopy is very useful method for planning therapy.