Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan 20;14(1):14.
doi: 10.1186/s12957-016-0767-y.

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

Sohei Satoi  1 , Hiroaki Yanagimoto  2 , Tomohisa Yamamoto  3 , Hideyoshi Toyokawa  4 , Satoshi Hirooka  5 , So Yamaki  6 , Singh Sapam Opendro  7 , Kentaro Inoue  8 , Taku Michiura  9 , Hironori Ryota  10 , Yoichi Matsui  11 , Masanori Kon  12
Affiliations

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

Sohei Satoi et al. World J Surg Oncol. .

Abstract

Background: The 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).

Methods: The 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.

Results: There 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.

Conclusions: The 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).

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The rate of emergence of ascites according to metastatic site diagnosed by staging laparoscopy. Figure 1 shows the curve of emergence of ascites in patients with locally advanced PDAC (LA, solid black line), with positive cytology (CY, solid grey line), with peritoneal metastasis (P, dotted grey line), and with liver metastasis (L, dotted black line). There were significant differences in the rate of emergence of ascites between LA and P (p < 0.001) and LA and CY (p = 0.033) groups
Fig. 2
Fig. 2
Survival curves according to metastatic site diagnosed by staging laparoscopy. a shows survival curve of patients with locally advanced PDAC (LA, solid black line), with positive cytology (CY, solid grey line), with peritoneal metastasis (P, dotted grey line), and with liver metastasis (L, dotted black line). There were significant differences between the survival curves of P and CY (p = 0.007) and P and LA (p = 0.04) groups. b shows survival curves of patients with locally advanced PDAC and positive cytology (LA + CY, solid black line) and with peritoneal metastasis and liver metastasis (P + L, dotted black line). The survival curve in LA + CY groups was significantly better than in P + L groups (p = 0.011)
See this image and copyright information in PMC

References

    1. Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet. 2004;363:1049–57. doi: 10.1016/S0140-6736(04)15841-8. - DOI - PubMed
    1. White R, Winston C, Gonen M, D’Angelica M, Jarnagin W, Fong Y, et al. Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg. 2008;206:445–50. doi: 10.1016/j.jamcollsurg.2007.09.021. - DOI - PubMed
    1. Satoi S, Yamamoto H, Toyokawa H, Inoue K, Wada K, Yamamoto T, et al. Selective Use of staging laparoscopy based on Carbohydrate Antigen 19–9 level and tumor size in patients with radiographicallydefined potentially or borderline resectable pancreatic cancer. Pancreas. 2011;40:426–32. doi: 10.1097/MPA.0b013e3182056b1c. - DOI - PubMed
    1. Stefanidis D, Grove KD, Schwesinger WH, Thomas CR., Jr The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Ann Oncol. 2006;17:189–99. doi: 10.1093/annonc/mdj013. - DOI - PubMed
    1. Hori Y, SAGES Guidelines Committee. Diagnostic laparoscopy guidelines: This guideline was prepared by the SAGES Guidelines Committee and reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), November 2007. Surg Endosc. 2008;22:1353-83. - PubMed

MeSH terms