title: Improving the diagnostic yield from staging laparoscopy for periampullary malignancies: the value of preoperative inflammatory markers and radiological tumor size.
abstract: OBJECTIVE
  The role of laparoscopy in staging periampullary malignancies is to detect small-volume metastatic disease not visible on preoperative imaging. Owing to improvements in preoperative imaging, some centers no longer undertake routine laparoscopic staging, whereas others still find it a useful pre-exploration tool.
  
  
  METHODS
  This study investigated the diagnostic yield of staging laparoscopies in 137 consecutive potentially resectable patients with periampullary malignancies. Serology on presentation, tumor size on computed tomography and proinflammatory markers such as C-reactive protein, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and Glasgow Prognostic Score were also examined to see if they were able to identify patients more likely to benefit from staging laparoscopy.
  
  
  RESULTS
  Laparoscopy identified occult disease in 16.1% of the patients. Only tumor diameter on cross-sectional imaging was related to an increase in diagnostic yield on staging laparoscopy. Area-under-curve values for tumor size and occult disease at laparoscopy were 0.8, with P = 0.0001.
  
  
  CONCLUSIONS
  Staging laparoscopy is a useful adjunct to computed tomography in staging periampullary cancers. Tumor size (especially >45 mm) is the only preoperative marker predictive of unexpected occult disease and may be used to select high-risk patients for laparoscopic staging.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK. gg43@le.ac.uk
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.forename: Vaux
authors.initials: V
authors.lastname: Cairns
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Neal
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology / Q000556:secondary / Q000601:surgery; D004739:England; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D010535:Laparoscopy; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology / Q000601:surgery; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D018836:Inflammation Mediators; D002097:C-Reactive Protein