Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA.
J Surg Oncol. 2009 Dec 15;100(8):663-9. doi: 10.1002/jso.21402.
The use of staging laparoscopy has been highly institutional dependent. We sought to assess the incidence of occult intra-abdominal metastases identified at the time of staging laparoscopy for patients with either potentially resectable or locally advanced pancreatic adenocarcinoma (LAPC). We also compared the rate of occult metastases in patients who underwent staging laparoscopy versus laparotomy.
Patients were confirmed to have potentially resectable or LAPC at a multidisciplinary hepatopancreaticobiliary conference. Patients with potentially resectable lesions were initially explored via staging laparoscopy or laparotomy, based on surgeon preference.
Over a 4-year period, 25 patients with potentially resectable tumors and 33 patients with LAPC were staged with laparoscopy, with an equivalent prevalence of occult metastases found at laparoscopy (28% potentially resectable vs. 33% LAPC, P = 0.8). Fifty-two patients with potentially resectable lesions were explored initially via laparotomy. Occult peritoneal metastases were more likely to be detected in patients with potentially resectable tumors that were explored via laparoscopy than via laparotomy (32% vs. 10%, P = 0.018).
Staging laparoscopy is more likely than open exploration to detect occult metastases. Current preoperative imaging inadequately identifies unresectable pancreatic adenocarcinoma; therefore, all patients with potentially resectable disease should undergo staging laparoscopy.
分期腹腔镜检查的应用高度依赖于机构。我们旨在评估在有潜在可切除或局部晚期胰腺腺癌（LAPC）的患者中进行分期腹腔镜检查时发现的隐匿性腹腔内转移的发生率。我们还比较了接受分期腹腔镜检查与剖腹手术的患者隐匿性转移的发生率。
患者在多学科肝胆胰脾会议上被确认为具有潜在可切除性或 LAPC。根据外科医生的偏好，具有潜在可切除病变的患者最初通过分期腹腔镜检查或剖腹手术进行探查。
在 4 年期间，25 例具有潜在可切除肿瘤的患者和 33 例 LAPC 患者接受了腹腔镜检查分期，腹腔镜检查时发现隐匿性转移的患病率相当（潜在可切除 28% vs. LAPC 33%，P=0.8）。52 例具有潜在可切除病变的患者最初通过剖腹手术进行探查。在通过腹腔镜检查而不是剖腹手术探查的潜在可切除肿瘤患者中，更有可能发现隐匿性腹膜转移（32% vs. 10%，P=0.018）。
分期腹腔镜检查比开放性探查更有可能发现隐匿性转移。目前的术前影像学不能充分识别不可切除的胰腺腺癌；因此，所有具有潜在可切除疾病的患者均应接受分期腹腔镜检查。
