STAGING LAPAROSCOPY AND PERITONEAL CYTOLOGY IN THE DEFINITIVE MANAGEMENT OF PATIENTS WITH PERIAMPULLAY AND PANCREATIC BODY AND TAIL TUMOURS

Document Type : Original Article

Authors

1 Department of Experimental and Clinical Surgery, Medical Research Institute

2 Department of Surgery, Faculty of Medicine

3 Department of Pathology, Medical Research Institute, University of Alexandria

Abstract

Aim: Staging laparoscopy and peritoneal cytology prevents unnecessary exploratory laparotmies among patients with 
pariampullary and pancreatic body and tail tumors. The study aims at evaluating this hypothesis. 
Patients and methods: The study was carried out on patients suffering from periampullary or pancreatic body and tail 
tumours who were scheduled for definitive resectional surgery of their tumours. Preoperative radiological staging was based on CT abdomen findings. Staging laparoscopy and peritoneal cytology were performed under general anaesthesia and the abdomen examined in a standardized sequence of 10 steps and table positions. 
Results: Staging laparoscopy was successfully performed on 20 patients without any morbidity or mortality, after excluding 18 patients for advanced disease. Staging laparoscopy and peritoneal cytology averted unjustified laparotomy for resectional surgery in 6 (30%) patients, 3 patients with pancreatic head tumours, 2 patients with distal bile duct tumours; 1 patient with pancreatic body and tail tumours and none in patients with tumours of the ampulla of Vater. The lesions that were detected by staging laparoscopy and missed by standard radiological staging were superficial liver metastasis, peritoneal seedlings and minimum ascites. 
Conclusion: In view of the results, we recommend the routine use of staging laparoscopy with peritoneal cytology in patients with pancreatic and bile duct tumours and not in patients with tumours of the ampulla of Vater.

Keywords

The Egyptian Journal of Surgery
Volume 23, Issue 4
October 2004
Pages 317-323

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