title: Staging of pancreatic cancer before and after neoadjuvant chemoradiation.
abstract: Neoadjuvant chemoradiation therapy is used at many institutions for treatment of localized adenocarcinoma of the pancreas. Accurate staging before neoadjuvant therapy identifies patients with distant metastatic disease, and restaging after neoadjuvant therapy selects patients for laparotomy and attempted resection. The aims of this study were to (1) determine the utility of staging laparoscopy in candidates for neoadjuvant therapy and (2) evaluate the accuracy of restaging CT following chemoradiation. Staging laparoscopy was performed in 98 patients with radiographically potentially resectable (no evidence of arterial abutment or venous occlusion) or locally advanced (arterial abutment or venous occlusion) adenocarcinoma of the pancreas. Unsuspected distant metastasis was identified in 8 (18%) of 45 patients with potentially resectable tumors and 13 (24%) of 55 patients with locally advanced tumors by CT. Neoadjuvant chemoradiation therapy and restaging CT were completed in a total of 103 patients. Thirty-three patients with potentially resectable tumors by restaging CT underwent surgical exploration and resections were performed in 27 (82%). Eleven (22%) of 49 patients with locally advanced tumors by restaging CT were resected, with negative margins in 55%; the tumors in these 11 patients had been considered locally advanced because of arterial involvement on restaging CT. Staging laparoscopy is useful for the exclusion of patients with unsuspected metastatic disease from aggressive neoadjuvant chemoradiation protocols. Following neoadjuvant chemoradiation, restaging CT guides the selection of patients for laparotomy but may overestimate unresectability to a greater extent than does prechemoradiation CT.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: White
authors.forename: E K
authors.initials: EK
authors.lastname: Paulson
authors.forename: K S
authors.initials: KS
authors.lastname: Freed
authors.forename: M T
authors.initials: MT
authors.lastname: Keogan
authors.forename: H I
authors.initials: HI
authors.lastname: Hurwitz
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.forename: M A
authors.initials: MA
authors.lastname: Morse
authors.forename: M R
authors.initials: MR
authors.lastname: Gottfried
authors.forename: J
authors.initials: J
authors.lastname: Baillie
authors.forename: M S
authors.initials: MS
authors.lastname: Branch
authors.forename: P S
authors.initials: PS
authors.lastname: Jowell
authors.forename: K M
authors.initials: KM
authors.lastname: McGrath
authors.forename: B M
authors.initials: BM
authors.lastname: Clary
authors.forename: T N
authors.initials: TN
authors.lastname: Pappas
authors.forename: D S
authors.initials: DS
authors.lastname: Tyler
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods