BACKGROUND: Recent advances in imaging and the increasing use of neoadjuvant therapy puts the contemporary utility of staging laparoscopy for patients with pancreatic adenocarcinoma (PDAC) into question. This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy. METHODS: Clinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001-2008) and group 2 (2009-2014). RESULTS: The study identified 1001 patients eligible for analysis, 331 (33%) of whom underwent a staging laparoscopy before exploration. An unnecessary laparotomy was prevented for 44.4% of the patients in period 1 and for 24% of the patients in period 2 (p < 0.001). Male gender [odds ratio (OR), 1.8; p < 0.05], preoperative resectability (borderline resectable OR 2.1; p < 0.019; locally advanced OR 7.6; p < 0.001), CA 19-9 levels higher than 394 U/L (OR 3.1; p < 0.001), no neoadjuvant chemotherapy (OR 2.7; p = 0.012), and pancreatic body or tail lesions (OR 1.8; p = 0.063) were predictive of occult metastatic disease. The developed scoring index demonstrated a c-statistic of 0.729. The observed-to-expected ratio for the index at every score level validated the index's model. A score cutoff at 4 was able to detect 76.1% of radiographically occult metastatic disease. CONCLUSION: The rate for unnecessary laparotomy among patients with PDAC has decreased in contemporary times, but unnecessary laparotomy still occurs for 1 in 4 patients. Using our scoring system, a cutoff of 4 allows 76% of radiographically occult metastases to be predicted, thereby selecting high-risk patients for laparoscopic biopsy and potentially avoiding a non-therapeutic laparotomy.
BACKGROUND: Recent advances in imaging and the increasing use of neoadjuvant therapy puts the contemporary utility of staging laparoscopy for patients with pancreatic adenocarcinoma (PDAC) into question. This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy. METHODS: Clinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001-2008) and group 2 (2009-2014). RESULTS: The study identified 1001 patients eligible for analysis, 331 (33%) of whom underwent a staging laparoscopy before exploration. An unnecessary laparotomy was prevented for 44.4% of the patients in period 1 and for 24% of the patients in period 2 (p < 0.001). Male gender [odds ratio (OR), 1.8; p < 0.05], preoperative resectability (borderline resectable OR 2.1; p < 0.019; locally advanced OR 7.6; p < 0.001), CA 19-9 levels higher than 394 U/L (OR 3.1; p < 0.001), no neoadjuvant chemotherapy (OR 2.7; p = 0.012), and pancreatic body or tail lesions (OR 1.8; p = 0.063) were predictive of occult metastatic disease. The developed scoring index demonstrated a c-statistic of 0.729. The observed-to-expected ratio for the index at every score level validated the index's model. A score cutoff at 4 was able to detect 76.1% of radiographically occult metastatic disease. CONCLUSION: The rate for unnecessary laparotomy among patients with PDAC has decreased in contemporary times, but unnecessary laparotomy still occurs for 1 in 4 patients. Using our scoring system, a cutoff of 4 allows 76% of radiographically occult metastases to be predicted, thereby selecting high-risk patients for laparoscopic biopsy and potentially avoiding a non-therapeutic laparotomy.
Authors: Eva Versteijne; Mustafa Suker; Karin Groothuis; Janine M Akkermans-Vogelaar; Marc G Besselink; Bert A Bonsing; Jeroen Buijsen; Olivier R Busch; Geert-Jan M Creemers; Ronald M van Dam; Ferry A L M Eskens; Sebastiaan Festen; Jan Willem B de Groot; Bas Groot Koerkamp; Ignace H de Hingh; Marjolein Y V Homs; Jeanin E van Hooft; Emile D Kerver; Saskia A C Luelmo; Karen J Neelis; Joost Nuyttens; Gabriel M R M Paardekooper; Gijs A Patijn; Maurice J C van der Sangen; Judith de Vos-Geelen; Johanna W Wilmink; Aeilko H Zwinderman; Cornelis J Punt; Casper H van Eijck; Geertjan van Tienhoven Journal: J Clin Oncol Date: 2020-02-27 Impact factor: 44.544
Authors: Thomas Hank; Marta Sandini; Cristina R Ferrone; Clifton Rodrigues; Maximilian Weniger; Motaz Qadan; Andrew L Warshaw; Keith D Lillemoe; Carlos Fernández-Del Castillo Journal: JAMA Surg Date: 2019-10-01 Impact factor: 14.766
Authors: Maxwell A Jambor; Amir Ashrafizadeh; Christopher B Nahm; Stephen J Clarke; Nick Pavlakis; Andrew Kneebone; George Hruby; Anthony J Gill; Anubhav Mittal; Jaswinder S Samra Journal: World J Surg Oncol Date: 2022-10-11 Impact factor: 3.253
Authors: Miles W Grunvald; Richard A Jacobson; Timothy M Kuzel; Sam G Pappas; Ashiq Masood Journal: Int J Mol Sci Date: 2020-10-16 Impact factor: 5.923