Explorative laparotomy or laparoscopy in patients with carcinoma of the stomach and pancreas?

SummaryThe remaining lifetime of patients with inoperable carcinoma of the stomach or pancreas is limited, and an explorative laparotomy performed only to confirm unresectability causes unnecessary emotional and physical stress to the patients. As an alternative we have for the last 18 months performed a laparoscopy in these patients and recorded complications, length of hospital stay and post-operative survival. For comparison we have retrospectively studied the records of similar patients who went through explorative laparotomy during the previous 3 years. Laparoscopy was found to reduce the number of post-operative complications, decrease the length of hospital stay and, when compared with laparotomy, increase the median remaining lifetime by more than 100% (P < 0.01). To reduce the number of futile laparot-omies in patients with incurable carcinoma of the stomach or pancreas, laparoscopy should be performed as an integrated part of the pre-operative assessment procedures.