Management of advanced pancreatic cancer: staging laparoscopy and immunochemotherapy--a new treatment strategy.

Background/Aims: Pancreatic cancer remains a challenging disease with a dismal prognosis. This study investigated the effect of two-route immunochemotherapy via artery (2-ICA) and usefulness of staging laparoscopy in the management of advanced cases. Methodology: Fifty-five patients admitted to our Department between April 1993 and April 2000 for resection of pancreatic cancer were the subjects of this study. Staging laparoscopy was performed in 16 of the patients, and 2-ICA was used to treat three of 16 because they were found to have small liver metastases during staging laparoscopy. Results: According to the TNM staging system (UICC), 9 (56%) in the 16 patients who underwent staging laparoscopy were found to have Stage IVb disease, 4 (25%) to have Stage IVa disease and only 3 (19%) to have Stage III disease. The three patients with small liver metastases received 2-ICA therapy. The metastatic lesions in the liver had completely disappeared in one patient, and decreased to about half the size in the other two cases. Conclusions: Staging laparoscopy is useful for correctly diagnosing tumor stage in pancreatic cancer patients and selecting appropriate treatment. The 2-ICA therapy is a new and effective method of treatment for advanced cases.