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Reappraisal of Staging Laparoscopy for Patients with Pancreatic Adenocarcinoma: A Contemporary Analysis of 1001 Patients

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent advances in imaging and the increasing use of neoadjuvant therapy puts the contemporary utility of staging laparoscopy for patients with pancreatic adenocarcinoma (PDAC) into question. This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy.

Methods

Clinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001–2008) and group 2 (2009–2014).

Results

The study identified 1001 patients eligible for analysis, 331 (33%) of whom underwent a staging laparoscopy before exploration. An unnecessary laparotomy was prevented for 44.4% of the patients in period 1 and for 24% of the patients in period 2 (p < 0.001). Male gender [odds ratio (OR), 1.8; p < 0.05], preoperative resectability (borderline resectable OR 2.1; p < 0.019; locally advanced OR 7.6; p < 0.001), CA 19-9 levels higher than 394 U/L (OR 3.1; p < 0.001), no neoadjuvant chemotherapy (OR 2.7; p = 0.012), and pancreatic body or tail lesions (OR 1.8; p = 0.063) were predictive of occult metastatic disease. The developed scoring index demonstrated a c-statistic of 0.729. The observed-to-expected ratio for the index at every score level validated the index’s model. A score cutoff at 4 was able to detect 76.1% of radiographically occult metastatic disease.

Conclusion

The rate for unnecessary laparotomy among patients with PDAC has decreased in contemporary times, but unnecessary laparotomy still occurs for 1 in 4 patients. Using our scoring system, a cutoff of 4 allows 76% of radiographically occult metastases to be predicted, thereby selecting high-risk patients for laparoscopic biopsy and potentially avoiding a non-therapeutic laparotomy.

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Disclosure

All authors have no relevant disclosures.

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Authors and Affiliations

  1. Department of Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Zhi Ven Fong MD, Carlos Fernández-del Castillo MD, Winta T. Mehtsun MD, Ilaria Pergolini MD, Andrew L. Warshaw MD, David C. Chang PhD, MPH, MBA, Keith D. Lillemoe MD & Cristina R. Ferrone MD

  2. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Donna Marie L. Alvino MD

Authors
  1. Zhi Ven Fong MD
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  2. Donna Marie L. Alvino MD
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  3. Carlos Fernández-del Castillo MD
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  4. Winta T. Mehtsun MD
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  5. Ilaria Pergolini MD
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  6. Andrew L. Warshaw MD
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  7. David C. Chang PhD, MPH, MBA
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  8. Keith D. Lillemoe MD
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  9. Cristina R. Ferrone MD
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Corresponding author

Correspondence to Cristina R. Ferrone MD.

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Fong, Z.V., Alvino, D.M.L., Fernández-del Castillo, C. et al. Reappraisal of Staging Laparoscopy for Patients with Pancreatic Adenocarcinoma: A Contemporary Analysis of 1001 Patients. Ann Surg Oncol 24, 3203–3211 (2017). https://doi.org/10.1245/s10434-017-5973-5

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  • DOI: https://doi.org/10.1245/s10434-017-5973-5

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