title: Predicting distant metastasis in patients with suspected pancreatic and periampullary tumors for selective use of staging laparoscopy.
abstract: BACKGROUND
  In patients with pancreatic or periampullary tumor, staging laparoscopy (SL) can detect metastases that are occult on computed tomography (CT), thereby precluding nontherapeutic laparotomy. Routine SL is not advocated, but some studies suggest its selective use. The aim of this study was to identify patients at risk for metastasis in whom SL could be beneficial.
  
  
  METHODS
  A consecutive series of patients who underwent laparotomy for a suspected pancreatic or periampullary tumor were analyzed. We included patients with a suspected resectable solid lesion and a recent high-quality CT scan. Patients with and without an intraoperatively encountered metastasis were compared. Regression analysis was performed to examine the association between various predictors and metastasis.
  
  
  RESULTS
  Data from 385 patients (mean age 63, 41% women) were analyzed. Distant metastasis was encountered in 79 patients (21%). Logistic regression analysis revealed the following key predictors for metastasis: tumor size on CT scan [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.16-1.76 per millimeter increase], weight loss (OR 1.28, 95% CI 1.01-1.63 per doubling the kilograms), and history of jaundice (OR 2.36, 95% CI 0.79-7.06). In patients with a tumor ≥3 cm and severe weight loss (≥10 kg) and in patients with a tumor ≥4 cm and moderate weight loss (≥5 kg), the proportion of patients with metastasis was >40%.
  
  
  CONCLUSIONS
  In patients with a suspected pancreatic or periampullary tumor, the tumor size, weight loss, and jaundice are key predictors of metastasis at exploration. SL might be beneficial in patients with a tumor ≥3 cm and severe weight loss and in those with a tumor ≥4 cm and moderate weight loss.
authors: Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Annelie
authors: A
authors: Slaar
authors: Wietse J
authors: WJ
authors: Eshuis
authors: Niels A
authors: NA
authors: van der Gaag
authors: C Yung
authors: CY
authors: Nio
authors: Olivier R C
authors: OR
authors: Busch
authors: Thomas M
authors: TM
authors: van Gulik
authors: Johannes B
authors: JB
authors: Reitsma
authors: Dirk J
authors: DJ
authors: Gouma
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D015431:Weight Loss