title: A clinical role of staging laparoscopy in patients with radiographically defined locally advanced pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  The aim of current study is to verify usefulness of staging laparoscopy (stag-lap) for patient's selection and to find prognostic factors in patients with radiographically defined locally advanced (RD-LA) pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  The LA disease was defined as an unresectable disease without distant organ metastasis based on resectability status of NCCN guideline in this study. Stag-lap was performed in 67 patients with RD-LA (2007-2012) which were divided into 4 groups according to metastatic site: group CY (peritoneal fluid or washing cytology positive and without any distant organ metastasis); group P (peritoneal dissemination); group L (liver metastasis); group LA (peritoneal fluid or washing cytology negative and without any distant organ metastasis). Clinical backgrounds, survival curves, and prognostic factors were investigated.
  
  
  RESULTS
  There were 16 patients in CY group (24%), 13 patients in P group (19%), 10 patients in L group (15%), and 28 patients in LA group (42%). Median survival time was 13 months in CY group and 11 months in LA group, which was significantly better than 7 months in P group, respectively (p<0.05). The rate of emergence of ascites in LA was significantly better than in CY or P groups (p<0.05). Multivariate analysis showed that the presence of partial response and administration of second-line chemotherapy were significantly independent prognostic factors.
  
  
  CONCLUSIONS
  The majority of PDAC patients with RD-LA had occult distant organ metastasis. Clinical features and survival curves were different depending on the site of occult distant organ metastasis. Administration of second-line chemotherapy and responsiveness to chemotherapy were associated with favorable prognosis. Staging laparoscopy should be routinely performed in patients with RD-LA PDAC (UMIN000019936).
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. satoi@hirakata.kmu.ac.jp.
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. yanagimh@hirakata.kmu.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. tomot1226@yahoo.co.jp.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. toyokawa@hirakata.kmu.ac.jp.
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. ss_largehill@yahoo.co.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirooka
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. yamaki@hirakata.kmu.ac.jp.
authors.forename: So
authors.initials: S
authors.lastname: Yamaki
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. drsos15@yahoo.co.in.
authors.forename: Singh Sapam
authors.initials: SS
authors.lastname: Opendro
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. inoueke@hirakata.kmu.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. michiurt@hirakata.kmu.ac.jp.
authors.forename: Taku
authors.initials: T
authors.lastname: Michiura
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. ryoutahr@hirakata.kmu.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ryota
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. matsui@hirakata.kmu.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata-City, Osaka, 573-1010, Japan. kon@hirakata.kmu.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis