Staging Laparoscopy in Pancreatic Cancer: A Potential Role for Advanced Laparoscopic Techniques

Schnelldorfer, Thomas; Gagnon, Andrew; Birkett, Richard; Reynolds, Gail; Murphy, Kristen; Jenkins, Roger L.

doi:10.1016/j.jamcollsurg.2014.02.018

Cited by 38 publications

(27 citation statements)

References 10 publications

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“…Slaar et al assessed data from 385 patients, who underwent laparotomy for suspected PDAC and reported OMD in 21% of the patients. More recent series report OMD incidence of 11% at laparotomy, whereas nationwide studies assess the same index at 18.5% and 24.4% in the Netherlands and Italy, respectively …”

Section: Discussionmentioning

confidence: 99%

“…Previous retrospective studies have estimated that number between 12% and 22%. 4 9 whereas nationwide studies assess the same index at 18.5% and 24.4% in the Netherlands and Italy, respectively. 23,24 In our institution, all patients with PDAC undergo a standardized pancreas protocol MDCT at the time of initial assessment.…”

Section: Multivariable Analysis and Predictors Of Omdmentioning

confidence: 99%

“…Historically, the answer to the patient’s question about the possibility of such an event happening is based on the surgeon’s anecdotal experience and may vary from 5% to 25%. Previous studies have reported that approximately 11% to 24% of patients with radiologically resectable PDAC are found to have OMD at exploration . However, the probability of OMD in patients with PDAC in the era of enhanced imaging remains practically unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported that approximately 11% to 24% of patients with radiologically resectable PDAC are found to have OMD at exploration. [4][5][6][7][8][9] However, the probability of OMD in patients with PDAC in the era of enhanced imaging remains practically unknown. Moreover, the associated risk factors for OMD in presumed resectable PDAC patients are also under debate.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Gemenetzis

Groot

Blair

et al. 2018

Journal of Surgical Oncology

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Background The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. Methods We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10‐year period. The cases were matched to a cohort of resected PDAC patients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. Results In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non‐OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19‐9 (CA 19‐9) values ( P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non‐OMD patients ( P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19‐9 > 192 U/mL. Conclusions Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19‐9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Multivariable Analysis and Predictors Of Omdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Gemenetzis

Groot

Blair

et al. 2018

Journal of Surgical Oncology

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“…The use of any preoperative staging modality is therefore limited, and must be used carefully in order to minimize the number of false-positives (patients with unresectable disease subjected to laparotomy) and false negatives (patients with resectable disease denied potentially curable surgical treatment based on an incorrect assumption of unresectability). The available diagnostic modalities differ in each of these regards, and therefore a combination of techniques must be employed in a logical and stepwise manner to most accurately determine disease stage prior to laparotomy [65]. …”

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confidence: 99%

The Pathogenesis, Diagnosis, and Management of Pancreatic Cancer

Malhotra¹,

Ahn²,

Bloomston

2015

J Gastrointest Dig Syst

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Pancreatic cancer is an aggressive and devastating disease accounting for 44,000 new cases per year in US. It is characterized by invasiveness, rapid progression and profound resistance to treatment. The majority of cases are diagnosed above age 65 with about 60% of cases at an advanced stage and 5 year survival less than 10%. Advances in molecular biology have greatly improved our understanding of pathogenesis of pancreatic cancer. Many patients have mutations of K-ras oncogene and various tumor suppressor genes are also investigated. Radical surgery remains the only curative treatment option for pancreatic cancer in early stages. For locally advanced, unresectable and metastatic disease, treatment is palliative, in form of adjuvant or neoadjuvant chemotherapy with or without radiotherapy. Gemcitabine based combinations have essentially failed to provide a substantial prolongation of survival and constitute treatment option only in patients with a good performance status. This article provides an overview of epidemiology; risks factors, molecular genetics, biomarkers, diagnostic modality and evidence based therapeutic options for resectable and palliative options for unresectable disease. Keywords: Pancreatic cancer; Diagnosis EpidemiologyPancreatic cancer is one of the most lethal human cancers and is the fourth leading cause of cancer-related deaths in the United States [1,2]. It is estimated that 38,460 of 45,220 people diagnosed with pancreatic cancer in the United States in 2013 will die of their disease, representing approximately 6% of total U.S. cancer deaths [1]. Typically a cancer of the elderly, only 13% of cases occur in patients younger than 55 years, whereas 69% of cases occur in those older than 65. There is a slight predilection for men over women in most countries. Furthermore the incidence of pancreatic cancer in the United States increased from 1999 to 2008, possibly because of the increasing prevalence of obesity and other unknown factors [1,[3][4][5]. Mortality rates have remained largely unchanged [6].The etiology of pancreatic cancer remains unclear, thus making specific risk factors allusive. Still, accepted associated risk factors include smoking, family history of chronic pancreatitis, advancing age, male gender, diabetes mellitus, obesity, non-O blood group, occupational exposures (to chlorinated hydrocarbon solvents and nickel), African American ethnic origin, a high-fat diet, diets high in meat and low in vegetables and folate, and possibly Helicobacter pylori infection and periodontal disease [7]. Findings of preliminary studies suggest that metformin could protect against development of pancreatic cancer [8,9]. A retrospective analysis of 302 patients with pancreatic cancer and diabetes found that metformin use was associated with increased survival at 2 years (30.1% vs. 15.4%; P=0.004) and increased overall survival (OS) (15.2 months vs. 11.1; P=0.009). The OS difference was significant only in patients without distant metastases and remained significant when insulin user...

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Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer

Allen

Gurusamy

Takwoingi

et al. 2016

Cochrane Database of Systematic Reviews

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Staging Laparoscopy in Pancreatic Cancer: A Potential Role for Advanced Laparoscopic Techniques

Cited by 38 publications

References 10 publications

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

The Pathogenesis, Diagnosis, and Management of Pancreatic Cancer

Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer

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