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

Hiroaki Yanagimoto,Satoshi Hirooka,Taku Michiura,So Yamaki,Kentaro Inoue,Singh Sapam Opendro,Masanori Kon,Hironori Ryota,Tomohisa Yamamoto,Hideyoshi Toyokawa,Sohei Satoi,Yoichi Matsui

doi:10.1186/s12957-016-0767-y

Hiroaki Yanagimoto, Satoshi Hirooka + Show 10 more

Open Access

https://doi.org/10.1186/s12957-016-0767-y

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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).

Highlights

The aim of current study is to verify usefulness of staging laparoscopy for patient’s selection and to find prognostic factors in patients with radiographically defined locally advanced (RD-LA) pancreatic ductal adenocarcinoma (PDAC)
We retrospectively assessed the rate of minute distant organ metastasis in PDAC patients with RD-LA, compared the clinical background and survival rate according to metastatic site, and analyzed the prognostic factors
In conclusion, staging laparoscopy is necessary for selecting patients with occult distant organ metastasis which is the majority population of patients with RD-LA PDAC

Summary

Introduction

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). Diagnostic laparoscopy guidelines [5] have proposed that staging laparoscopy should be considered after high-quality imaging studies have excluded metastatic disease in appropriately selected patients with locally advanced pancreatic adenocarcinoma. We had some clinical questions on the diagnoses and clinical courses in radiographically defined locally advanced (RD-LA) patients, such as the frequency of occult distant organ metastasis, the survival difference according to the occult distant organ metastatic site, and the prognostic factors in this patient population. We retrospectively assessed the rate of minute distant organ metastasis in PDAC patients with RD-LA, compared the clinical background and survival rate according to metastatic site, and analyzed the prognostic factors

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