Abstract
Background
The necessity of the staging laparoscopy in patients with pancreatic cancer is still
debated. The objective of this study was to assess the yield of staging laparoscopy
for detecting occult metastases in patients with resectable or borderline resectable
pancreatic cancer.
Method
This was a post-hoc analysis of the randomized controlled PREOPANC trial in which
patients with resectable or borderline resectable pancreatic cancer were randomized
between preoperative chemoradiotherapy or immediate surgery. Patients assigned to
preoperative treatment underwent a staging laparoscopy prior to preoperative treatment
according to protocol, to avoid unnecessary chemoradiotherapy in patients with occult
metastatic disease.
Results
Of the 246 included patients, 7 did not undergo surgery. A staging laparoscopy was
performed in 133 patients (55.6%) and explorative laparotomy in 106 patients (44.4%).
At staging laparoscopy, occult metastases were detected in 13 patients (9.8%); 12
liver metastases and 1 peritoneal metastasis. At direct explorative laparotomy, occult
metastases were found in 9 patients (8.5%); 6 with liver metastases, 1 with peritoneal
metastases, and 2 with metastases at multiple sites. One patient had peritoneal metastases
at exploration after a negative staging laparoscopy. Patients with occult metastases
were more likely to receive palliative chemotherapy if found with staging laparoscopy
compared to laparotomy (76.9% vs. 30.0%, p = 0.040).
Conclusions
Staging laparoscopy detected occult metastases in about 10% of patients with resectable
or borderline resectable pancreatic cancer. These patients were more likely to receive
palliative systemic chemotherapy compared to patients in whom occult metastases were
detected with laparotomy. A staging laparoscopy is recommended before planned resection.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States.Cancer Res. 2014; 74: 2913-2921
- Pancreatic cancer.Lancet. 2011; 378: 607-620
- Pancreatic adenocarcinoma.(version: 1.2021), Available at:http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdfDate: 2020Date accessed: January 1, 2021
- The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy.Ann Surg. 1996; 223: 134-140
- Reappraisal of staging laparoscopy for patients with pancreatic adenocarcinoma: a contemporary analysis of 1001 patients.Ann Surg Oncol. 2017; 24: 3203-3211
- Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument.HPB. 2015; 17: 131-139
- Diagnostic laparoscopy prior to neoadjuvant therapy in pancreatic cancer is high yield: an analysis of outcomes and costs.J Gastrointest Surg. 2017; 21: 1420-1427
- The role of staging laparoscopy in resectable and borderline resectable pancreatic cancer: a systematic review and meta-analysis.Dig Surg. 2019; 36: 251-260
- Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer.Cochrane Database Syst Rev. 2016; 7 (CD009323)
- Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial.J Clin Oncol. 2020; 38: 1763-1773
- Preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC trial): study protocol for a multicentre randomized controlled trial.Trials. 2016; 17: 127
- Yield of staging laparoscopy before treatment of locally advanced pancreatic cancer to detect occult metastases.Eur J Surg Oncol. 2019; 45: 1906-1911
- Indications for staging laparoscopy in pancreatic cancer.HPB. 2016; 18: 13-20
- Value of visual inspection, bimanual palpation, and intraoperative ultrasonography during hepatic resection for liver metastases of colorectal carcinoma.World J Surg. 2011; 35: 2779-2787
- Intraoperative ultrasound with contrast medium in resective pancreatic surgery: a pilot study.World J Surg. 2011; 35: 2521-2527
- Fundamentals and developments in fluorescence-guided cancer surgery.Nat Rev Clin Oncol. 2022; 19: 9-22
- Potentially curable pancreatic adenocarcinoma: ASCO clinical practice guideline update.J Clin Oncol. 2019; 37: 2082-2088
- Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2015; 26: v56-v68
- Locally advanced unresectable pancreatic cancer: American society of clinical oncology clinical practice guideline summary.J Oncol Pract. 2017; 13: 265-269
- Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC).Dig Liver Dis. 2018; 50: 1257-1271
- Staging laparoscopy not only saves patients an incision, but may also help them live longer.Ann Surg Oncol. 2018; 25: 1009-1016
- Time to reconsider staging laparoscopy in pancreatic cancer?.J Clin Oncol. 2020; 38: 2944-2945
Article info
Publication history
Published online: December 26, 2022
Accepted:
December 22,
2022
Received in revised form:
November 27,
2022
Received:
July 24,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
☆Not based on previous communication to a society or meeting.
Identification
Copyright
© 2022 Published by Elsevier Ltd.
