Laparoscopic Staging

  • Matthew H. Katz
  • Abdool R. Moossa
  • Michael Bouvet
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Although pancreatic cancer currently ranks tenth in cancer incidence, it represents the fourth leading cause of cancer death in the United States among patients of both sexes (1). The therapeutic options available to individuals with this disease are primarily determined by disease stage. Patients with small, localized tumors are typically candidates for surgical resection by pancreaticoduodenectomy or distal pancreatectomy, which currently offer the only chance for longterm survival (2). In major, specialized centers, median survival of up to 20 months can now be achieved after complete tumor resection (3–5), with 5-year survival rates approaching 40–50% in selected patients (6, 7). Unfortunately, only 10–15% of patients with pancreatic cancer are found to have resectable tumors at the time of diagnosis, with the remainder harboring either locoregional extension or distant metastases (8) which preclude effective surgical therapy. For this overwhelming majority of patients presenting with advanced disease, treatment strategies are currently limited, and patient prognosis is therefore extremely poor—overall, individuals with advanced pancreatic malignancy have a 5-year survival rate less than 1%, with an overwhelming majority dead within 1 year of diagnosis (9, 10).

Timely diagnosis and staging thus play a fundamental role in the evaluation of patients with pancreatic cancer. Two goals are paramount: ( 1 ) diagnosis of the disease early in its natural history, thereby providing patients an opportunity for curative surgical therapy; and ( 2 ) preoperative discrimination between those patients with early stage tumors in whom tumor resection is warranted, and those with unresectable disease, and consequently limited survival, in whom the morbidity and expense of major surgery should routinely be avoided. Until recently, tissue diagnosis, staging, and assessment of resectability were all accomplished during exploratory laparotomy. Over the past two decades, however, significant advances in diagnostic and staging technologies, such as computed tomography (CT), endoscopic ultrasonography (EUS), and staging laparoscopy, as well as the development of minimally invasive palliative strategies, have permitted a more selective approach to open surgery ( 11 ).


Pancreatic Cancer Superior Mesenteric Artery Unresectable Disease Staging Laparoscopy Peritoneal Cytology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Matthew H. Katz
    • 1
  • Abdool R. Moossa
    • 2
  • Michael Bouvet
    • 3
  1. 1.The University of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of SurgeryUniversity of California, San DiegoSan DiegoUSA
  3. 3.San Diego and Moores Cancer CenterUniversity of CaliforniaLa JollaUSA

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