Impact of Laparoscopic Staging in the Treatment of Pancreatic Cancer

Abstract

THE MAIN GOAL of staging protocols for pancreatic cancer is to categorize patients into groups to optimize strategic decisions and response to treatment. Three groups are frequently recognized. The first group includes individuals who present with metastatic disease. Surgery is best avoided in these patients in view of their short survival time, and chemotherapy is their principal treatment modality.^1,2 The second group comprises patients with advanced local disease (ie, major vascular invasion) but without metastases. These patients can benefit from external beam radiotherapy (EBRT) combined with chemotherapy and, according to their response, are candidates for intraoperative radiation (IORT).^3,4 A third and last subpopulation is patients with resectable tumors. These individuals may benefit from transfer to a tertiary referral center where pancreatic resection can be performed with low mortality rates.^5,6 They may also be candidates for protocols that combine surgery and IORT or local hepatic chemotherapy and aim to improve current surgical results.