A clinical role of staging laparoscopy in patients with radiographically defined locally advanced pancreatic ductal adenocarcinoma

Abstract

BackgroundThe aim of current study is to verify usefulness of staging laparoscopy (stag-lap) for patient’s selection and to find prognostic factors in patients with radiographically defined locally advanced (RD-LA) pancreatic ductal adenocarcinoma (PDAC).MethodsThe LA disease was defined as an unresectable disease without distant organ metastasis based on resectability status of NCCN guideline in this study. Stag-lap was performed in 67 patients with RD-LA (2007–2012) which were divided into 4 groups according to metastatic site: group CY (peritoneal fluid or washing cytology positive and without any distant organ metastasis); group P (peritoneal dissemination); group L (liver metastasis); group LA (peritoneal fluid or washing cytology negative and without any distant organ metastasis). Clinical backgrounds, survival curves, and prognostic factors were investigated.ResultsThere were 16 patients in CY group (24 %), 13 patients in P group (19 %), 10 patients in L group (15 %), and 28 patients in LA group (42 %). Median survival time was 13 months in CY group and 11 months in LA group, which was significantly better than 7 months in P group, respectively (p < 0.05). The rate of emergence of ascites in LA was significantly better than in CY or P groups (p < 0.05). Multivariate analysis showed that the presence of partial response and administration of second-line chemotherapy were significantly independent prognostic factors.ConclusionsThe majority of PDAC patients with RD-LA had occult distant organ metastasis. Clinical features and survival curves were different depending on the site of occult distant organ metastasis. Administration of second-line chemotherapy and responsiveness to chemotherapy were associated with favorable prognosis. Staging laparoscopy should be routinely performed in patients with RD-LA PDAC (UMIN000019936).

Multicenter Phase II Study of Intravenous and Intraperitoneal Paclitaxel With S-1 for Pancreatic Ductal Adenocarcinoma Patients With Peritoneal Metastasis

“…Our previous report also revealed that ascites occurred within 1-year after initiation of chemotherapy in approximately 70% of patients with peritoneal metastasis diagnosed by staging laparoscopy for radiographically defined locally advanced PDAC. 5 Considering that the patients with peritoneal metastasis generally have a particularly poor prognosis, the present survival results are encouraging.…”

“…Moreover, the presence of peritoneal metastasis is associated with development of intestinal obstruction, massive ascites, and malnutrition, leading to poor performance status, 4 which, in turn, deprives the patients of the opportunity to receive chemotherapy. 5 MST of these patients has been reported to be 6 weeks from a population-based study in the Netherlands, 3 and 7 weeks in another series of 73 patients with malignant ascites. 4 Pharmacokinetic studies revealed that anticancer drugs administered systemically do not necessarily enter the peritoneal cavity.…”

Preoperative predictors for early recurrence of resectable pancreatic cancer

“…Considering those reports, one option may be to administer preoperative chemotherapy for RPC patients who have high preoperative serum CA19-9 values, intending to exclude those patients who have the potential for early recurrence after surgery and to control minimally distant metastasis in those patients. It has recently been reported that staging laparoscopy in patients with local advanced pancreatic ductal adenocarcinoma is effective for selecting patients with occult distant organ metastasis [33]. To perform staging laparoscope for RPC patients having high preoperative CA19-9 values may make better patient selection for preoperative therapy.…”

Survival benefit of intravenous and intraperitoneal paclitaxel with S-1 in pancreatic ductal adenocarcinoma patients with peritoneal metastasis: a retrospective study in a single institution

“…They reported an MST of 7 months in patients with PDAC with peritoneal dissemination, and 6 months in patients with locally advanced disease who had positive peritoneal washing cytology during staging laparoscopy. Our previous report also revealed an MST of 8 months in PDAC patients with peritoneal dissemination and 13 months in patients with locally advanced disease who had positive peritoneal washing cytology diagnosed by staging laparoscopy for radiographically defined locally advanced PDAC [5]. Moreover, we also reported that pancreas body-tail tumors and tumor size >42 mm in 110 patients with radiographicallydefined locally advanced PDAC were significantly risk factors for peritoneal metastasis [19].…”