Predicting Distant Metastasis in Patients With Suspected Pancreatic and Periampullary Tumors for Selective Use of Staging Laparoscopy

Slaar, Annelie; Eshuis, Wietse J.; Gaag, Niels A. van der; Nio, C. Yung; Busch, Olivier R.; Gulik, Thomas M. van; Reitsma, Johannes B.; Gouma, Dirk J.

doi:10.1007/s00268-011-1204-6

Cited by 20 publications

(23 citation statements)

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“…Although resection rates have increased along with increasing centralization of pancreatic surgery in the Netherlands, a radical resection is deemed impossible in a considerable proportion of patients who undergo surgical exploration. The present nationwide results are largely in line with earlier institutional reports, showing that 12–22 per cent of patients who undergo surgical exploration for pancreatic cancer do not have tumour resection because of metastatic disease, and 6–26 per cent because of unresectable M0 (locally advanced) disease. The present study also shows that an increased surgical exploration rate over time paralleled an increased resection rate, mostly owing to a decrease in unresectable M0 disease detected at exploration.…”

Section: Discussionsupporting

confidence: 91%

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Geest

Lemmens

Hingh

et al. 2017

British Journal of Surgery

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Section: Discussionsupporting

confidence: 91%

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Geest

Lemmens

Hingh

et al. 2017

British Journal of Surgery

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“…Historically, the answer to the patient’s question about the possibility of such an event happening is based on the surgeon’s anecdotal experience and may vary from 5% to 25%. Previous studies have reported that approximately 11% to 24% of patients with radiologically resectable PDAC are found to have OMD at exploration . However, the probability of OMD in patients with PDAC in the era of enhanced imaging remains practically unknown.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Gemenetzis

Groot

Blair

et al. 2018

Journal of Surgical Oncology

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Background The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. Methods We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10‐year period. The cases were matched to a cohort of resected PDAC patients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. Results In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non‐OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19‐9 (CA 19‐9) values ( P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non‐OMD patients ( P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19‐9 > 192 U/mL. Conclusions Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19‐9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.

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“…Preoperative imaging was more extensive in these studies. So far, only two studies have shown any factors (i.e., Blumgart T-stage) that increase the diagnostic yield in these patients [7, 13], whereas several other predictors (e.g., CA19-9, tumor size) of unresectable disease at SL have been identified and validated for pancreatic cancer patients [18–23]. …”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of staging laparoscopy for detecting metastasized or locally advanced perihilar cholangiocarcinoma: a systematic review and meta-analysis

et al. 2016

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BackgroundDespite extensive preoperative staging, still almost half of patients with potentially resectable perihilar cholangiocarcinoma (PHC) have locally advanced or metastasized disease upon exploratory laparotomy. The value of routine staging laparoscopy (SL) in these patients remains unclear with varying results reported in the literature. The aim of the present systematic review was to provide an overview of studies on SL in PHC and to define its current role in preoperative staging.MethodsA systematic review and meta-analysis were performed in PubMed and EMBASE regarding studies providing data on the diagnostic accuracy of SL in PHC. Primary outcome measures were the overall yield and sensitivity to detect unresectable disease. Secondary outcomes were the yield and sensitivity for recent studies (after 2010) and large study cohorts (≥100 patients) and specific (metastatic) lesions. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool.ResultsFrom 173 records, 12 studies including 832 patients met the inclusion criteria. The yield of SL in PHC varied from 6.4 to 45.0 % with a pooled yield of 24.4 % [95 % confidence interval (CI) 16.4–33.4]. Sensitivity to detect unresectable disease ranged from 31.6 to 75 % with a pooled sensitivity of 52.2 % (95 % CI 47.1–57.2). Sensitivity was highest for peritoneal metastases (80.7 %, 95 % CI 70.9–88.3). Subgroup analysis revealed that the yield and sensitivity tended to be lower for studies after 2010. Considerable heterogeneity was detected among the studies.ConclusionsThe results of the pooled analyses suggest that one in four patients with potentially resectable PHC benefits from SL. Given considerable heterogeneity, a trend to lower yield in more recent studies and further improvement of preoperative imaging over time, the routine use of SL seems discouraging. Studies that identify predictors of unresectability, that enable selection of patients who will benefit the most from this procedure, are needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-016-4788-y) contains supplementary material, which is available to authorized users.

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Predicting Distant Metastasis in Patients With Suspected Pancreatic and Periampullary Tumors for Selective Use of Staging Laparoscopy

Cited by 20 publications

References 46 publications

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Diagnostic accuracy of staging laparoscopy for detecting metastasized or locally advanced perihilar cholangiocarcinoma: a systematic review and meta-analysis

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