title: Risk factors for latent distant organ metastasis detected by staging laparoscopy in patients with radiologically defined locally advanced pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  We aimed to identify risk factors for latent distant organ metastasis in patients with radiographically defined locally advanced (RDLA) pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  RDLA disease was defined as unresectable disease without distant organ metastasis based on resectability status by NCCN guidelines. Between January 2005 and November 2015, 110 consecutive patients underwent staging laparoscopy to rule out latent distant metastasis. Univariate and multivariate analyses were performed to identify risk factors for latent distant organ metastasis or peritoneal metastasis (PM), defined as peritoneal dissemination and/or positive peritoneal lavage cytology (PPC).
  
  
  RESULTS
  Latent distant organ metastasis was diagnosed by staging laparoscopy in 62 patients. PPC was found in 23%, peritoneal dissemination in 19%, and liver metastasis in 15%. Univariate analysis showed tumor location, preoperative CA 19-9 level and tumor size, and multivariate analysis revealed tumor size >55 mm and CA 19-9 level >60 IU/ml as risk factors for latent distant metastasis. Multivariate analysis showed pancreas body-tail tumors and tumor size >42 mm as risk factors for PM; 65.4% of pancreas body-tail tumors >42 mm had PM.
  
  
  CONCLUSIONS
  Patients with large pancreas body-tail tumors and high CA 19-9 level are at greater risk for latent distant organ metastasis or PM, and should undergo staging laparoscopy routinely for accurate diagnosis (UMIN000023125).
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Ilhan
authors: I
authors: Karabicak
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Sohei
authors: S
authors: Satoi
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Hiroaki
authors: H
authors: Yanagimoto
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Tomohisa
authors: T
authors: Yamamoto
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Satoshi
authors: S
authors: Hirooka
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: So
authors: S
authors: Yamaki
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Hisashi
authors: H
authors: Kosaka
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Kentaro
authors: K
authors: Inoue
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Yoichi
authors: Y
authors: Matsui
authors: Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
authors: Masanori
authors: M
authors: Kon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000378:metabolism; D018395:CA-19-9 Antigen / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen
keywords: Accurate staging; Diagnostic laparoscopy; Locally advanced; Pancreatic ductal adenocarcinoma; Risk factors