Staging laparoscopy in pancreatic cancer: a potential role for advanced laparoscopic techniques.
BACKGROUND
The role of staging laparoscopy in pancreatic cancer in the age of high-resolution CT scans is under debate. This study's aim is to evaluate the efficacy of staging laparoscopy in this disease.


METHODS
A retrospective cohort study was conducted evaluating patients who underwent operative treatment for radiographic stage I to III pancreatic cancer between July 2003 and October 2012. Radiographic follow-up was 94% at 6 months.


RESULTS
Of 274 patients who met inclusion criteria, 136 underwent staging laparoscopy, which identified radiographic occult distant metastases in 2% (3 of 136). However, subsequent laparotomy identified an additional 9% (12 of 136) harboring distant metastases in regions not visualized on standard staging laparoscopy; specifically, the posterior liver surface, paraduodenal retroperitoneum, proximal jejunal mesentery, and lesser sac. The remaining 138 patients underwent initial staging laparotomy, which showed similar results identifying radiographic occult distant disease in 11% (15 of 138). Within 6 months after the operation, peritoneal or subcapsular liver metastases developed in an additional 6% (15 of 257)-disease that potentially could have been diagnosed at the time of operation-providing a false-negative rate of 88% for staging laparoscopy compared with 36% for staging laparotomy.


CONCLUSIONS
Despite the availability of high-resolution CT scans, occult distant metastases can still be found in 11% of patients during the operation. In the absence of reliable risk factors to predict distant metastases, staging laparoscopy should be offered to all patients with radiographic localized disease. However, the results favor extended laparoscopic staging with evaluation of the posterior liver surface, mobilization of the duodenum, evaluation of the proximal jejunal mesentery, and visualization of the lesser sac.
Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA. Electronic address: thomas.schnelldorfer@lahey.org.
Thomas
T
Schnelldorfer
Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA.
Andrew I
AI
Gagnon
Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA.
Richard T
RT
Birkett
Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA.
Gail
G
Reynolds
Department of Operating Room, Lahey Hospital and Medical Center, Burlington, MA.
Kristen M
KM
Murphy
Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA.
Roger L
RL
Jenkins
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010190:Pancreatic Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies