Diagnostic Laparoscopy for Patients with Potentially Resectable Pancreatic Adenocarcinoma: Is It Cost-Effective in the Current Era?

Abstract

Cost analysis indicates that the case-specific or routine use of laparoscopy in pancreatic cancer does not add significantly to the overall expense of treatment and supports the use of laparoscopy in patients with known or suspected pancreatic adenocarcinoma.

Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature

“…Although a cost‐analysis in the United States indicated that the routine use of laparoscopic staging did not add significantly to the overall expense of treatment, 84 the routine use of staging laparoscopy in peripancreatic cancer was not found to be beneficial 85 . The role of staging laparoscopy and laparoscopic ultrasonography definitely have a complimentary role to radiological imaging in patients with locally advanced disease by helping to reduce the number of non‐therapeutic laparotomies 38 …”

The role of laparoscopy and laparoscopic ultrasound in the preoperative staging of pancreatico-biliary cancers – A meta-analysis

“…80% of articles extracted were review articles, whilst the remaining did not assess SL/LUS as staging modality. Of the remaining 41 articles, 12 studies did not satisfy the eligibility criteria; 22 were for potentially resectable PPC and 7 for PBC [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37] (Supplemental information, Table ST1 to attain pneumoperitoneum and were therefore excluded from our analysis. Therefore, a total of 2,827 patients with PPC and 478 patients with PBC, deemed potentially resectable on preoperative staging, were included for analysis.…”

Staging laparoscopy for proximal pancreatic cancer in a magnetic resonance imaging-driven practice: what's it worth?

“…they represent the average total costs of hospitalization for all patients undergoing operative management), they do not capture those incidental costs that may be associated with SL. Furthermore, although this may reflect either the location of the deposit or operator error, 7–35% of patients receiving SL are found to have metastases that are discovered at laparotomy 6,9,17,21,22 …”

“…Unfortunately, CT is often inadequate in determining unresectability. Although the accuracy of CT has improved over time, as many as 10–48% of those deemed resectable on CT are taken to laparotomy for ultimately unresectable disease 2,5–10 . Some studies have explored the role of magnetic resonance imaging (MRI) in this setting, but these are few and increasingly dated 4,11–14 .…”

“…Firstly, even presuming a lack of human error, the camera may not capture deep hepatic and low omental metastases. Indeed, 7–35% of patients receiving SL have metastases that are later discovered at laparotomy 6,9,17,21,22 . Secondly, the potential yield of SL declines as the accuracy of preoperative imaging improves 23 .…”