Laparoscopic screening of surgical candidates with pancreatic cancer or liver tumors

Abstract

Background: Patients with colorectal or pancreatic cancers may have peritoneal implants which are too small to be detected by current radiologic imaging techniques. Since such implants often preclude surgical removal of the primary tumor or isolated metastasis, their detection prior to open abdominal exploration may spare patients the morbidity of a large abdominal incision when there is no benefit to resection and lifespan is limited.

Methods: In the past 30 months, patients with pancreatic cancer, hepatoma, or isolated colorectal cancer metastases, who were candidates for surgical resection on the basis of standard radiologic scans, were examined with the laparoscope through a 10-mm periumbilical incision prior to undertaking open abdominal exploration. If unexpected implants were noted, biopsy was obtained through a 5-mm port placed through a convenient site.

Results: Since January 1993, 11 patients with pancreatic carcinoma, three patients with primary hepatic malignancies, and 12 patients with isolated metastases from colorectal cancers have undergone laparoscopic examination prior to celiotomy. Eight of these patients had unexpected peritoneal or liver involvement which precluded resection. Laparoscopy was successful in detecting disease in six such patients (75%).

Conclusion: Although adding 20–30 min to the operative time when unrevealing, laparoscopy provided an effective way to avoid celiotomy in patients with carcinomatosis.