TY - JOUR
T1 - The yield of staging laparoscopy for resectable and borderline resectable pancreatic cancer in the PREOPANC randomized controlled trial
AU - van Dongen, Jelle C
AU - Versteijne, Eva
AU - Bonsing, Bert A
AU - Mieog, J Sven D
AU - de Hingh, Ignace H J T
AU - Festen, Sebastiaan
AU - Patijn, Gijs A
AU - van Dam, Ronald
AU - van der Harst, Erwin
AU - Wijsman, Jan H
AU - Bosscha, Koop
AU - van der Kolk, Marion
AU - de Meijer, Vincent E
AU - Liem, Mike S L
AU - Busch, Olivier R
AU - Besselink, Marc G H
AU - van Tienhoven, Geertjan
AU - Groot Koerkamp, Bas
AU - van Eijck, Casper H J
AU - Suker, Mustafa
AU - Dutch Pancreatic Cancer Group
N1 - Copyright © 2022. Published by Elsevier Ltd.
PY - 2023/4
Y1 - 2023/4
N2 - BACKGROUND: The necessity of the staging laparoscopy in patients with pancreatic cancer is still debated. The objective of this study was to assess the yield of staging laparoscopy for detecting occult metastases in patients with resectable or borderline resectable pancreatic cancer.METHOD: This was a post-hoc analysis of the randomized controlled PREOPANC trial in which patients with resectable or borderline resectable pancreatic cancer were randomized between preoperative chemoradiotherapy or immediate surgery. Patients assigned to preoperative treatment underwent a staging laparoscopy prior to preoperative treatment according to protocol, to avoid unnecessary chemoradiotherapy in patients with occult metastatic disease.RESULTS: Of the 246 included patients, 7 did not undergo surgery. A staging laparoscopy was performed in 133 patients (55.6%) and explorative laparotomy in 106 patients (44.4%). At staging laparoscopy, occult metastases were detected in 13 patients (9.8%); 12 liver metastases and 1 peritoneal metastasis. At direct explorative laparotomy, occult metastases were found in 9 patients (8.5%); 6 with liver metastases, 1 with peritoneal metastases, and 2 with metastases at multiple sites. One patient had peritoneal metastases at exploration after a negative staging laparoscopy. Patients with occult metastases were more likely to receive palliative chemotherapy if found with staging laparoscopy compared to laparotomy (76.9% vs. 30.0%, p = 0.040).CONCLUSIONS: Staging laparoscopy detected occult metastases in about 10% of patients with resectable or borderline resectable pancreatic cancer. These patients were more likely to receive palliative systemic chemotherapy compared to patients in whom occult metastases were detected with laparotomy. A staging laparoscopy is recommended before planned resection.
AB - BACKGROUND: The necessity of the staging laparoscopy in patients with pancreatic cancer is still debated. The objective of this study was to assess the yield of staging laparoscopy for detecting occult metastases in patients with resectable or borderline resectable pancreatic cancer.METHOD: This was a post-hoc analysis of the randomized controlled PREOPANC trial in which patients with resectable or borderline resectable pancreatic cancer were randomized between preoperative chemoradiotherapy or immediate surgery. Patients assigned to preoperative treatment underwent a staging laparoscopy prior to preoperative treatment according to protocol, to avoid unnecessary chemoradiotherapy in patients with occult metastatic disease.RESULTS: Of the 246 included patients, 7 did not undergo surgery. A staging laparoscopy was performed in 133 patients (55.6%) and explorative laparotomy in 106 patients (44.4%). At staging laparoscopy, occult metastases were detected in 13 patients (9.8%); 12 liver metastases and 1 peritoneal metastasis. At direct explorative laparotomy, occult metastases were found in 9 patients (8.5%); 6 with liver metastases, 1 with peritoneal metastases, and 2 with metastases at multiple sites. One patient had peritoneal metastases at exploration after a negative staging laparoscopy. Patients with occult metastases were more likely to receive palliative chemotherapy if found with staging laparoscopy compared to laparotomy (76.9% vs. 30.0%, p = 0.040).CONCLUSIONS: Staging laparoscopy detected occult metastases in about 10% of patients with resectable or borderline resectable pancreatic cancer. These patients were more likely to receive palliative systemic chemotherapy compared to patients in whom occult metastases were detected with laparotomy. A staging laparoscopy is recommended before planned resection.
U2 - 10.1016/j.ejso.2022.12.011
DO - 10.1016/j.ejso.2022.12.011
M3 - Article
C2 - 36585300
SN - 0748-7983
VL - 49
SP - 811
EP - 817
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 4
ER -