ABSTRACT
Diagnostic laparoscopy, either routinely or selectively, has become an integral part of the staging of many patients with pancreatic cancer. In most situations when unresectable disease is found at laparoscopy, as either liver metastasis or peritoneal implants, life expectancy is quite short and operative palliation is not generally indicated. In a series of 155 patients from Memorial Sloan-Kettering Cancer Center who were found to have unresectable pancreatic adenocarcinoma at the time of staging laparoscopy, only 2% required an open procedure to palliate biliary or gastric obstruction during their remaining lifetime ( 24 ). Jaundiced patients without gastric outlet obstruction, who are found to have metastatic disease at the time of staging laparoscopy, can be palliated successfully with biliary stenting alone in most circumstances. Laparoscopic biliary bypass is an option and surgical series,
involving limited numbers of patients, have shown satisfactory short-and long-term results from this approach ( 25-29 ). Patients with gastric outlet obstruction, who are determined to have unresectable disease at the time of staging laparoscopy, should be considered for laparoscopic gastrojejunostomy, especially when there are anatomic constraints that will limit the success of endoluminal gastroduodenal stenting.
