Staging laparoscopy not only saves patients an incision, but may also help them live longer

Abstract

Objective: Approximately 17% of patients with pancreatic adenocarcinoma (PDAC) “resectable” by imaging criteria have metastatic disease on exploration. Our aim was to assess the potential impact of staging laparoscopy versus upfront laparotomy in patients with metastatic PDAC. Methods: Clinicopathologic data was retrospectively collected for all patients with PDAC undergoing an operation with curative intent between 2001 and -2015 at a single institution. Results: Of the 1,001 patients undergoing surgical evaluation, 160 had unsuspected metastatic PDAC. Staging laparoscopy was performed in 60% (96/160) of patients, while 40% (64/160) underwent an exploratory laparotomy with or without prophylactic bypass. There were no differences in patient demographics and preoperative CA 19-9 levels between the staging laparoscopy and exploratory laparotomy groups. However, staging laparoscopy was more often performed for pancreatic body/tail lesions (80.0% vs 50.5% for pancreatic head lesions, p<0.001). Patients who only underwent laparoscopy started palliative chemotherapy more quickly (19.5 days vs 43.2 days in the laparotomy group, p<0.001). No difference was appreciated in patients requiring post-operative procedures (38.5% vs 26.6% laparotomy group, p=0.116). The median overall survival for the staging laparoscopy group (12.2 months) was significantly longer than the laparotomy group (8.3 months, p=0.002). In a cox regression analysis adjusting for clinicopathologic variables, staging laparoscopy was associated with significantly improved overall survival when compared to the laparotomy group (HR 0.596, 95% C.I. 0.400–0.887, p=0.009; Figure). Conclusion: For patients diagnosed with metastatic PDAC at the time of surgical exploration, staging laparoscopy was associated with a shorter time to chemotherapy and improved survival duration when compared to those explored without laparoscopy.