BACKGROUND: There is currently no standardized regimen for management of borderline resectable pancreatic cancer (BRPC), and treatment includes varying sequences of surgery, chemotherapy, and/or radiation. This study examines the diagnostic yield and cost of performing staging diagnostic laparoscopy (SDL) prior to neoadjuvant therapy (NAT) in BRPC. METHODS: Sequential patients treated for BRPC between January 2010 and October 2013 were included. SDL was adopted in a staged fashion due to surgeon preference, and included biopsy of visible lesions and washings for cytology. Cost ratios (CRs) were calculated to compare the direct cost of the SDL versus no-SDL groups and to compare patients with positive versus negative SDL. RESULTS: Of 116 patients evaluated for BRPC, 75 patients underwent SDL and 19 (25%) revealed occult metastatic disease. Sixteen patients had a positive biopsy and three had positive cytology alone. There was no difference in overall treatment cost (CR 0.95, 95% CI 0.62-1.37), oncologic treatment (CR 0.66, 95% CI 0.32-1.23), or remaining surgical treatment (CR 1.14, 95% CI 0.77-1.71) for patients who underwent SDL compared to those who did not. Patients with a positive SDL incurred lower overall cost compared to those with a negative SDL (CR 0.23, 95% CI 0.16-0.32) due to lack of further surgery or radiation, and less intensive chemotherapy regimens. CONCLUSIONS: SDL prior to NAT is a useful adjunct to CT to diagnose occult metastatic disease in BRPC.
BACKGROUND: There is currently no standardized regimen for management of borderline resectable pancreatic cancer (BRPC), and treatment includes varying sequences of surgery, chemotherapy, and/or radiation. This study examines the diagnostic yield and cost of performing staging diagnostic laparoscopy (SDL) prior to neoadjuvant therapy (NAT) in BRPC. METHODS: Sequential patients treated for BRPC between January 2010 and October 2013 were included. SDL was adopted in a staged fashion due to surgeon preference, and included biopsy of visible lesions and washings for cytology. Cost ratios (CRs) were calculated to compare the direct cost of the SDL versus no-SDL groups and to compare patients with positive versus negative SDL. RESULTS: Of 116 patients evaluated for BRPC, 75 patients underwent SDL and 19 (25%) revealed occult metastatic disease. Sixteen patients had a positive biopsy and three had positive cytology alone. There was no difference in overall treatment cost (CR 0.95, 95% CI 0.62-1.37), oncologic treatment (CR 0.66, 95% CI 0.32-1.23), or remaining surgical treatment (CR 1.14, 95% CI 0.77-1.71) for patients who underwent SDL compared to those who did not. Patients with a positive SDL incurred lower overall cost compared to those with a negative SDL (CR 0.23, 95% CI 0.16-0.32) due to lack of further surgery or radiation, and less intensive chemotherapy regimens. CONCLUSIONS:SDL prior to NAT is a useful adjunct to CT to diagnose occult metastatic disease in BRPC.
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Authors: Quisette P Janssen; Stefan Buettner; Mustafa Suker; Berend R Beumer; Pietro Addeo; Philippe Bachellier; Nathan Bahary; Tanios Bekaii-Saab; Maria A Bali; Marc G Besselink; Brian A Boone; Ian Chau; Stephen Clarke; Mary Dillhoff; Bassel F El-Rayes; Jessica M Frakes; Derek Grose; Peter J Hosein; Nigel B Jamieson; Ammar A Javed; Khurum Khan; Kyu-Pyo Kim; Song Cheol Kim; Sunhee S Kim; Andrew H Ko; Jill Lacy; Georgios A Margonis; Martin D McCarter; Colin J McKay; Eric A Mellon; Sing Yu Moorcraft; Ken-Ichi Okada; Alessandro Paniccia; Parag J Parikh; Niek A Peters; Hans Rabl; Jaswinder Samra; Christoph Tinchon; Geertjan van Tienhoven; Eran van Veldhuisen; Andrea Wang-Gillam; Matthew J Weiss; Johanna W Wilmink; Hiroki Yamaue; Marjolein Y V Homs; Casper H J van Eijck; Matthew H G Katz; Bas Groot Koerkamp Journal: J Natl Cancer Inst Date: 2019-08-01 Impact factor: 13.506
Authors: Daniel R Principe; Patrick W Underwood; Murray Korc; Jose G Trevino; Hidayatullah G Munshi; Ajay Rana Journal: Front Oncol Date: 2021-07-15 Impact factor: 6.244