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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2017

01-10-2017 | Pancreatic Tumors

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

Authors: Zhi Ven Fong, MD, Donna Marie L. Alvino, 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

Published in: Annals of Surgical Oncology | Issue 11/2017

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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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Metadata
Title
Reappraisal of Staging Laparoscopy for Patients with Pancreatic Adenocarcinoma: A Contemporary Analysis of 1001 Patients
Authors
Zhi Ven Fong, MD
Donna Marie L. Alvino, 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
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5973-5

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