The Society of Surgical Oncology, inc.
The American Society of Breast Surgeons.
Annals of Surgical Oncology

Log in | Register

Staging Laparoscopy Not Only Saves Patients an Incision, But May Also Help Them Live Longer

Naomi M. Sell MD MHS, Zhi Ven Fong MD MPH, Carlos Fernandez del Castillo MD, Motaz Qadan MD, PhD, Andrew L. Warshaw MD, David Chang PhD, MPH, MBA, Keith D. Lillemoe MD, Cristina R. Ferrone MD
Pancreatic Tumors
Volume 25, Issue 4 / April , 2018

Abstract

Background

Approximately 20–40% of patients with “resectable” pancreatic adenocarcinoma (PDAC) by imaging criteria have metastatic disease on exploration. Our aim was to assess the potential impact of staging laparoscopy versus upfront laparotomy in “resectable” patients found to have metastatic PDAC.

Methods

Clinicopathologic data was retrospectively collected for all patients with PDAC undergoing an operation with curative intent between 2001–2015 at a single institution.

Results

Of the 1001 patients undergoing surgical evaluation, 151 had unsuspected metastatic PDAC. Staging laparoscopy was performed in 59% (89/151) of patients, while 41% (62/151) underwent an exploratory laparotomy with or without prophylactic bypass. There were no differences in patient demographics and preoperative CA 19-9 levels between the staging laparoscopy and exploratory laparotomy groups. However, staging laparoscopy was more often performed for pancreatic body/tail lesions (85% vs 60% for pancreatic head lesions, p < 0.001). Patients who only underwent laparoscopy started palliative chemotherapy more quickly (17.9 days vs 39.9 days in the laparotomy group, p < 0.001). There was no difference in the 30 day or lifetime incidence of postoperative cholangitis, gastric outlet obstruction, or biliary stent placement between groups. The median overall survival for the staging laparoscopy group (11.4 months) was significantly longer than the laparotomy group (8.3 months, p < 0.001). In a cox regression analysis adjusting for clinicopathologic variables, staging laparoscopy was associated with significantly improved overall survival when compared to the laparotomy group (HR 0.53, 95% C.I. 0.34–0.82, p = 0.005).

Conclusion

For patients diagnosed with metastatic PDAC at the time of surgical exploration, staging laparoscopy was associated with a shorter time to chemotherapy and improved overall survival when compared to those explored without laparoscopy.

Add a comment



0 comment(s)

ANNALS NOW ON SOCIAL MEDIA!

Follow the journal on Twitter and Facebook

Help to expand the reach of the journal to support the research and practice needs of surgical oncologists and their patients.