How staging laparoscopy informs pancreatic cancer care

TOPLINE:

Researchers found that, prior to resection, performing a minimally invasive staging procedure on newly diagnosed patients with pancreatic cancer helped identify metastatic disease and cancer stage, and prompted a change in management in about one in five patients.

METHODOLOGY:

• The study included 1,004 patients who underwent staging laparoscopy at the Mayo Clinic, Rochester, Minn., from January 2017 to December 2021.
• Patients’ median age was 66 years; 48% of the cohort were female.
• Tumor location was proximal in 644 patients (64%) and distal in 360 patients (36%); median tumor size was 29 mm.
• Upfront resectable disease was present in 351 patients (35%), and borderline resectable or locally advanced anatomy was present in 653 (65%).

TAKEAWAY:

• Overall, 180 patients had a positive staging laparoscopy because of gross metastatic disease (n = 140) and/or positive peritoneal cytology (n = 96); patients who underwent neoadjuvant chemotherapy before staging laparoscopy had lower rates of positive laparoscopy (14% vs. 22%; P = .002).
• When the analysis was restricted to chemo-naive patients who had concurrent peritoneal lavage performed, 95 of 419 patients (23%) had positive laparoscopy.
• Among 721 patients who had a staged procedure with peritoneal washings, 151 (21%) had confirmed metastatic disease; cytology was positive in 96 (13%).
• Among patients with positive staging laparoscopy, median overall survival was 11 months in those with gross metastatic disease and 13 months in those with positive peritoneal cytology only (P = .40).

IN PRACTICE:

“Staging laparoscopy should be considered in the majority of patients prior to resection and/or initiation of neoadjuvant therapy, specifically in patients with high-risk features such as indeterminate extrapancreatic lesions on imaging, young age, large tumor size, distal tumor location, or elevated serum tumor markers,” the authors concluded.

SOURCE:

The study, led by Hallbera Gudmundsdottir, MD, of the Mayo Clinic was published in the Journal of the American College of Surgeons in June.

LIMITATIONS:

Staging laparoscopy may have been performed in higher-risk patients in earlier years of the study. The Mayo Clinic is a high-volume pancreatic surgery center that sees high-risk patients with advances lesions. This study population may not be generalizable to the those at other centers.

DISCLOSURES:

The authors did not disclose any financial interests.

A version of this article first appeared on Medscape.com.