Laparoscopic staging in patients with newly diagnosed pancreatic cancer

© Springer Science+Business Media, LLC, part of Springer Nature 2018. Prompt accurate staging is paramount in managing patients with newly diagnosed pancreatic cancer. Initially, diagnosis and staging are undertaken using contrastenhanced multidetector computerized tomography (CE-MDCT) or magnetic resonance imaging (MRI), supplemented with endoscopic ultrasound in selected cases. Staging laparoscopy (SL) with or without laparoscopic ultrasound (L-LUS) has been found to detect occult disease in 13-28% of patients with pancreatic cancer who are considered potentially resectable on imaging; however, between 1% and 30% of patients thought to be resectable on SL/L-LUS have subsequently been found to have unresectable disease. The clinical utility of SL/L-LUS can be enhanced by adopting a selective approach, only undertaking SL/L-LUS when one or more criteria are present, including (1) presumed pancreatic primary >3 cm diameter, (2) lesions in the body and tail of the pancreas, (3)CA19-9>150 kU/L (>300when total bilirubin >35 micromol/L), and (4) platelet/lymphocyte ratio >150. The judicious use of SL/L-LUS and cross-sectional imaging are complementary; however, the advent of PETCT may lead to improvements in the detection of small previously radiologically occult metastases and may reduce the future role of SL/L-LUS.