Staging laparoscopy is mandatory for the treatment of pancreatic cancer to avoid missing radiologically negative metastases

Takadate, Tatsuyuki; Morikawa, Takanori; Ishida, Masaharu; Aoki, Shuichi; Hata, Tatsuo; Iseki, Masahiro; Miura, Takayuki; Ariake, Kyohei; Maeda, Shin; Kawaguchi, Koji; Masuda, Koichi; Ohtsuka, Hideo; Mizuma, Masamichi; Hayashi, Hiroki; Nakagawa, Kazuhiko; Motoi, Fuyuhiko; Kamei, Takashi; Naitoh, Takeshi; Unno, Michiaki

doi:10.1007/s00595-020-02121-4

Cited by 39 publications

(29 citation statements)

References 32 publications

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“…However, the early detection of asymptomatic peritoneal dissemination by imaging modalities is still a challenge, especially at the emergence stage 25 . More intensive and precise assessment of resectability, including the exploration of radiographically invisible occult metastases during the initial diagnosis, can help determine the best therapeutic approach for each patient with PDAC and can distinguish resectable from unresectable cancer 7 . To the best of our knowledge, this is the first report that shows a direct comparison of ctDNA prevalence and allele frequencies stratified by the degree of metastatic spread, including radiographically invisible occult metastases.…”

Section: Discussionmentioning

confidence: 99%

“…However, resectability classification is usually based on computed tomography (CT)/ magnetic resonance imaging (MRI). Therefore, radiographically invisible occult metastases can be found incidentally during abdominal exploration, even in resectable PDAC cases, with a prevalence reaching 20%‐40% 7‐10 . Only systemic chemotherapy using regimens such as GEM plus nab‐paclitaxel and FOLFIRINOX (5‐fluorouracil, oxaliplatin, irinotecan, and leucovorin) has been used to treat patients with unresectable PDAC having distant metastasis 11,12 .…”

Section: Introductionmentioning

confidence: 99%

“…Recent evidence indicates that staging laparoscopy can be used as a less‐invasive diagnostic approach to explore occult metastases, thus avoiding unnecessary surgical abdominal exploration 7,13 . Staging laparoscopy can provide detailed information about radiographically invisible metastatic spread, including peritoneal lavage cytology, and can reduce the time spent in hospital and the time to the initiation of subsequent treatment 8 .…”

Section: Introductionmentioning

confidence: 99%

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Circulating tumor DNA as a predictive marker for occult metastases in pancreatic cancer patients with radiographically non‐metastatic disease

Hata

Mizuma

Iseki

et al. 2021

J Hepato Biliary Pancreat

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Purpose To elucidate the effectiveness of circulating tumor DNA (ctDNA) for predicting occult metastases in patients with pancreatic cancer without apparent metastases. Methods Circulating tumor DNA was obtained from plasma samples of 165 patients with pancreatic cancer and analyzed using droplet digital PCR. The prevalence and allele frequencies of ctDNA were compared across different patterns and degrees of metastatic spread. Results Of the 142 patients without apparent metastases who underwent abdominal exploration, 39 (27.5%) harbored occult metastases including positive peritoneal lavage cytology. The prevalence of ctDNA was significantly higher in patients with occult metastases than in those without (41.0% vs 14.6%, P = .001). A markedly high prevalence of ctDNA was observed in patients with radiographically visible metastases (78.3%). ctDNA was found to be an independent predictor of the presence of occult metastases (odds ratio: 3.113, P = .039), and its diagnostic performance in combination with tumor markers had a sensitivity of 66.7% and a specificity of 81.6%. In 62 treatment‐naïve patients without metastases, multivariate analysis identified the presence of ctDNA as an independent prognostic factor (hazard ratio: 6.311, P = .001). Conclusion Circulating tumor DNA can help predict the presence of occult metastases in pancreatic cancer patients with radiographically non‐metastatic disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Circulating tumor DNA as a predictive marker for occult metastases in pancreatic cancer patients with radiographically non‐metastatic disease

Hata

Mizuma

Iseki

et al. 2021

J Hepato Biliary Pancreat

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“…However, based on current data, this approach should be used (13) with occult metastases identified in 29% of patients with resectable tumor on CT scan. (14) EUS-FNA or CT-guided percutaneous core needle biopsy (CT-CNB) is mandatory and provide histologic diagnostic before neoadjuvant therapy, as well an assessment of the serum levels of CA 19-9. (12) This approach increase the amount of patients becoming eligible for surgery, avoiding unnecessary operations on tumors with aggressive biology that evolve despite neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Distal pancreatectomy with celiac axis resection for locally advanced pancreatic carcinoma: case report

Zanatto¹,

Beato²,

Vieira³

et al. 2021

Brazilian Journal of Oncology

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Long-term survival of pancreatic ductal adenocarcinoma after surgery is still rare. One of the main reasons for unresectability is the tumor invasion of the main vessels, such as the celiac axis, common hepatic artery and superior mesenteric artery. The optimal management of these patients is controversial. Despite the challenges on the topic, we present a case of pancreatic ductal adenocarcinoma with invasion of the celiac axis treated with pancreatectomy and vascular resection plus perioperative chemoradiotherapy. After 30 months of follow-up, hepatic and peritoneal recurrence were identified. Palliative chemotherapy was administered until disease progression and death in March 2020. Surgical resection when used in selected patients, proved to be feasible with acceptable morbidity. Besides that, the aggressive surgical approach associated with multimodal schemes provided an improvement in disease-free and overall survival.

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“…Based on these observations, some authors recommend the strategy of routinely incorporating baseline staging laparoscopy before neoadjuvant therapy for patients with PDAC [ 72 ]. The criteria usually used to indicate exploratory laparoscopy are tumor size >3 cm, body and tail tumor location, and CA 19-9 levels of >200 UI [ 73 ]. In the SLING Trial, Oba et al demonstrated that staging laparoscopy with contrast-enhanced intraoperative ultrasound and indocyanine green fluorescence imaging was effective in such subgroups of patients, with the technique detecting ROMPC in 12 out of the 31 patients enrolled [ 74 ].…”

Section: Surgical Considerations Following Neoadjuvant Therapy For Rpcmentioning

confidence: 99%

Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer

Lambert

Schwarz

Ducreux

et al. 2021

Cancers

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Complete surgical resection is the cornerstone of curative therapy for resectable pancreatic adenocarcinoma. Upfront surgery is the gold standard, but it is rarely curative. Neoadjuvant treatment is a logical option, as it may overcome some of the limitations of adjuvant therapy and has already shown some encouraging results. The main concern regarding neoadjuvant therapy is the risk of disease progression during chemotherapy, meaning the opportunity to undergo the intended curative surgery is missed. We reviewed all recent literature in the following areas: major surveys, retrospective studies, meta-analyses, and randomized trials. We then selected the ongoing trials that we believe are of interest in this field and report here the results of a comprehensive review of the literature. Meta-analyses and randomized trials suggest that neoadjuvant treatment has a positive effect. However, no study to date can be considered practice changing. We considered design, endpoints, inclusion criteria and results of available randomized trials. Neoadjuvant treatment appears to be at least a feasible strategy for patients with resectable pancreatic cancer.

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Staging laparoscopy is mandatory for the treatment of pancreatic cancer to avoid missing radiologically negative metastases

Cited by 39 publications

References 32 publications

Circulating tumor DNA as a predictive marker for occult metastases in pancreatic cancer patients with radiographically non‐metastatic disease

Circulating tumor DNA as a predictive marker for occult metastases in pancreatic cancer patients with radiographically non‐metastatic disease

Distal pancreatectomy with celiac axis resection for locally advanced pancreatic carcinoma: case report

Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer

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