The role of laparoscopy in advanced pancreatic cancer diagnosis.

BACKGROUND/AIMS: Histological diagnosis between ductal and endocrine carcinoma is imperative in patients with advanced and unresectable pancreatic malignancies because of the different treatment modalities and prognoses. Whenever percutaneous and endoscopic ultrasound-guided pancreatic fine needle aspiration (FNA) fails to obtain a diagnostic specimen, a laparoscopic approach may be employed. METHODS: Between October 2002 and July 2004, 19 patients with demonstrated unresectable pancreatic cancer underwent laparoscopy to obtain a cytohistological diagnosis. RESULTS: The mean operative time was 83 min. Laparoscopy showed the presence of liver metastases in 15 patients that were correctly diagnosed by preoperative imaging in only 8 cases (53\%). Overall 5 pancreatic FNA and 16 liver and peritoneal biopsies were obtained. In 1 patient the procedure was abandoned due to hypercapnia. In 16 patients (84\%) a cytohistological diagnosis was obtained. There were no mortalities. CONCLUSIONS: Laparoscopic biopsy of advanced unresectable pancreatic cancer is a feasible, safe and reliable procedure to obtain a cytohistological diagnosis whenever ultrasound-guided FNA fails.