Is laparoscopy still needed for staging resectable pancreatic cancer?
Abstract only 168 Background: Imaging for pancreatic cancer has demonstrated increased accuracy in staging patients before resection. Many propose diagnostic laparoscopy is therefore unnecessary before laparotomy and resection. Pancreatic cancer still has a high incidence of peritoneal and liver met...
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| Published in: | Journal of clinical oncology Vol. 30; no. 4_suppl; p. 168 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
01-02-2012
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| Online Access: | Get full text |
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| Summary: | Abstract only 168 Background: Imaging for pancreatic cancer has demonstrated increased accuracy in staging patients before resection. Many propose diagnostic laparoscopy is therefore unnecessary before laparotomy and resection. Pancreatic cancer still has a high incidence of peritoneal and liver metastases that may be radiographically occult. Our hypothesis is that laparoscopy is still necessary to detect occult disease and avoid non-curative laparotomy in cases of peri-pancreatic malignancy. Methods: Patient data were collected at a large, academic community-based tertiary care center with a specialized pancreatic team. Retrospective chart review was performed for patients surgically treated for peri-pancreatic neoplasms between the years 2005-2011. Patients with adenocarcinoma were the focus of this study. All patients had triple phase CT imaging for staging and to assess resectability. Patients who had laparoscopy (group 1) were identified and compared to those who did not (group 2). Results: Two hundred and two patients from 2005-2011 with pancreatic neoplasms were identified as radiographically resectable. Of these, 107 had pancreatic adenocarcinoma (53%). In the first group, 80 patients underwent diagnostic laparoscopy (75%) and metastatic disease was identified in 8 cases (10%). Laparotomy for resection was performed for the remaining 72 patients and 6 were found to have metastatic disease that was missed during laparoscopy. The overall prevalence of metastatic disease in this group was 17.5%. In the second group, 27 patients underwent laparotomy without laparoscopy. Four of these patients(15%) were found to have metastatic disease. The sensitivity of laparoscopy to detect radiographically occult metastases was 70%. Laparoscopy still missed 43% (6/14) of patients ultimately found to have metastatic disease in this group. Conclusions: Occult metastases were still found in 15%-17.5% of patients despite modern CT scan imaging. Even though laparoscopy missed some metastases when compared to laparotomy, our results show that 10% of patients were spared an unnecessary laparotomy. Laparoscopy should still play a role in staging patients with radiographically resectable pancreatic cancer. |
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| ISSN: | 0732-183X 1527-7755 |
| DOI: | 10.1200/jco.2012.30.4_suppl.168 |