Munizay Paracha1, Kathryn Van Orden1, Gregory Patts2, Jennifer Tseng1, David McAneny1, Teviah Sachs3,4. 1. Department of Surgery, Boston University School of Medicine, Boston, MA, USA. 2. Boston University School of Public Health, Boston, MA, USA. 3. Department of Surgery, Boston University School of Medicine, Boston, MA, USA. teviah.sachs@bmc.org. 4. Department of Surgical Oncology, Boston Medical Center, 820 Harrison Avenue, FGH Building - Suite 5007, Boston, MA, 02118, USA. teviah.sachs@bmc.org.
Abstract
BACKGROUND: Routine preoperative staging in pancreas cancer is controversial. We sought to evaluate the rates of diagnostic laparoscopy (DLAP) for pancreatic cancer. METHODS: We queried the National Surgical Quality Improvement Program for patients with pancreas cancer (2005-2013) and compared groups who underwent DLAP, exploratory laparotomy (XLAP), pancreas resection (RSXN) or therapeutic bypass (THBP). We compared demographics, comorbidities, postoperative complications, 30-day mortality (Chi-square P < 0.05) and trends over time (R2 0-1). RESULTS: We identified 17,138 patients (RSXN 81.8%, XLAP 16.5%, THBP 8.2%, and DLAP 12.9%), with some having multiple CPT codes. Only 10.3% (n = 1432) of RSXN patients underwent DLAP prior to resection. XLAP occurred in 49.5% of non-RSXN patients, of whom 67.1% had no other operation. The percentage of patients undergoing RSXN increased 20.3% over time (R2 0.81), while DLAP decreased 52.6% (R2 0.92). XLAP patients without other operations decreased from 4.2 to 2.4%, although not linearly (R2 0.31). Only 10.3% of XLAP had a diagnostic laparoscopy as well, leaving nearly 90% of these patients with an exploratory laparotomy without RSXN or THBP. DISCUSSION: Diagnostic laparoscopy for pancreas malignancy is becoming less common but could benefit a subset of patients who undergo open exploration without resection or therapeutic bypass.
BACKGROUND: Routine preoperative staging in pancreas cancer is controversial. We sought to evaluate the rates of diagnostic laparoscopy (DLAP) for pancreatic cancer. METHODS: We queried the National Surgical Quality Improvement Program for patients with pancreas cancer (2005-2013) and compared groups who underwent DLAP, exploratory laparotomy (XLAP), pancreas resection (RSXN) or therapeutic bypass (THBP). We compared demographics, comorbidities, postoperative complications, 30-day mortality (Chi-square P < 0.05) and trends over time (R2 0-1). RESULTS: We identified 17,138 patients (RSXN 81.8%, XLAP 16.5%, THBP 8.2%, and DLAP 12.9%), with some having multiple CPT codes. Only 10.3% (n = 1432) of RSXNpatients underwent DLAP prior to resection. XLAP occurred in 49.5% of non-RSXNpatients, of whom 67.1% had no other operation. The percentage of patients undergoing RSXN increased 20.3% over time (R2 0.81), while DLAP decreased 52.6% (R2 0.92). XLAPpatients without other operations decreased from 4.2 to 2.4%, although not linearly (R2 0.31). Only 10.3% of XLAP had a diagnostic laparoscopy as well, leaving nearly 90% of these patients with an exploratory laparotomy without RSXN or THBP. DISCUSSION: Diagnostic laparoscopy for pancreas malignancy is becoming less common but could benefit a subset of patients who undergo open exploration without resection or therapeutic bypass.
Authors: Travis E Grotz; Jennifer A Yonkus; Cornelius A Thiels; Susanne G Warner; Robert R McWilliams; Amit Mahipal; Tanios S Bekaii-Saab; Sean P Cleary; Michael L Kendrick; Mark J Truty Journal: Ann Surg Oncol Date: 2022-08-16 Impact factor: 4.339
Authors: C Mattevi; J Garnier; U Marchese; J Ewald; M Gilabert; F Poizat; G Piana; J R Delpero; O Turrini Journal: BMC Surg Date: 2020-08-05 Impact factor: 2.102