Opportunity Lost? Diagnostic Laparoscopy in Patients with Pancreatic Cancer in the National Surgical Quality Improvement Program Database

Paracha, Munizay; Orden, Kathryn Van; Patts, Gregory; Tseng, Jennifer F.; McAneny, David; Sachs, Teviah E.

doi:10.1007/s00268-018-4855-8

Cited by 19 publications

(8 citation statements)

References 27 publications

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“…Najah et al indicated that single-incision laparoscopic peritoneal exploration could be safely applied in the management of patients with peritoneal metastases (17). Several studies have concluded that compared to laparotomy, diagnostic laparoscopy routinely used not only saves patients an incision, but also shortens the intervals between operation and adjuvant therapy (18)(19)(20). However, given the high cost, low proportion of metastasis and limited additional value, it is still controversial whether staging laparoscopy should be applied routinely or selectively (21).…”

Section: Discussionmentioning

confidence: 99%

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

Ge¹,

Li²,

Ma³

et al. 2021

Gland Surg

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Background: Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, most of patients lose the chance of surgery due to the unresectable disease at the time of diagnosis. Despite the improvement of radiological imaging, a portion of patients intended for radical resection were proven to be unresectable at surgical exploration due to occult metastasis.Methods: Patients who were aimed to undergo radical pancreatectomy for PDAC from 2010 to 2019 were reviewed retrospectively. All patients included underwent diagnostic laparoscopic exploration. Patients were divided into two groups depending on whether distant metastasis were encountered during exploration.Univariate and multivariate logistic regression analyses were used to identify risk factors for occult metastasis.A nomogram to predict occult metastasis of PDAC on exploration was developed and evaluated.Results: A total of 273 patients who underwent diagnostic laparoscopic exploration were included in this study. Nineteen (7.0%) patients were found with distant metastasis during exploration. Multivariate logistic regression analysis showed that ALT>40U/L, CA19-9, CA125 and regional nodes enlargement were independent predictors for occult metastasis. Incorporating these four factors, the nomogram achieved concordance index of 0.799, with a well-fitted calibration curve.Conclusions: Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.

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Section: Discussionmentioning

confidence: 99%

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

Ge¹,

Li²,

Ma³

et al. 2021

Gland Surg

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“…Diagnostic laparoscopy can help to rule out previously undetected local invasion or abdominal metastases, avoid futile explorative laparotomies, and define treatment paths, especially in patients at high risk for locally advanced tumors or systemic involvement 51–53…”

Section: Introductionmentioning

confidence: 99%

<p>Pancreatic cancer in young adults: changes, challenges, and solutions</p>

Primavesi¹,

Stättner²,

Schlick³

et al. 2019

OTT

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Despite improvements in multidisciplinary treatments, survival of pancreatic cancer (PC) patients remains dismal. Studies dealing with early onset pancreatic cancer (EOPC) patients are scarce. In this review, we discuss differences between EOPC and late-onset pancreatic cancer based on findings in original papers and reviews with a focus on morphology, genetics, clinical outcomes and therapy. In conclusion, families with a positive history of PC and patients with BRCA 1 or 2 mutations should be monitored. Patients with EOPC usually present with better overall fitness compared to the average PC population, however often with even more aggressive cancer behaviour. Therefore, potent state-of-the-art multi-modal systemic therapies should be applied whenever possible. Large-scale registries and randomized clinical trials dealing with EOPC in regard to distinct biology and outcome are warranted.

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“…Routine laparoscopy was not performed, and this could be a drawback of our study; we suppose that any included patients could have been spared exploration if laparoscopy was performed. However, laparoscopy is not routinely performed worldwide and a recent large series reported that about 10% of patients underwent this procedure [17]. Similarly, its relevance remains under debate.…”

Section: Discussionmentioning

confidence: 99%

Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

Mattevi

Garnier

Marchese

et al. 2020

Preprint

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Purpose: To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC).Methods: From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000–March 2011) and period #2 (April 2011–August 2019). Results: All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P<.01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P<.01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (24% vs 25%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, PALNs invasion rate (0.4% vs 4.6%; P<0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9mm vs 6.4mm (P<.01), respectively) when the resection was not done. In multivariate analysis, CA 19-9<500U/mL (P<.01), and liver DW-MRI prescription (P<.01) favoured the resection. Conclusions: Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

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Opportunity Lost? Diagnostic Laparoscopy in Patients with Pancreatic Cancer in the National Surgical Quality Improvement Program Database

Cited by 19 publications

References 27 publications

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

<p>Pancreatic cancer in young adults: changes, challenges, and solutions</p>

Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

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