Indication For Staging Laparoscopy Research Articles

Successful Laparoscopic RAMPS for PDAC Combined with a Single Peritoneal Dissemination Associated with EUS-FNA: A Case Report

Background: The indication for staging laparoscopy (SL) for pancreatic ductal adenocarcinoma (PDAC) is unclear. The incidence of peritoneal dissemination from PDAC, related to endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was reported at 2.2%. Case Presentation: A 68-year-old woman presented with poor glycemic control. Abdominal ultrasonography revealed a low-density lesion (22 mm diameter) in the pancreatic body. EUS-FNA was performed to diagnose PDAC. However, no distant metastasis or local infiltration was observed in CECT. Due to high carbohydrate antigen 19-9 (CA19-9) level (663.7 U/mL), SL was performed. A single peritoneal dissemination was found and resected from the lesser sac, although lavage cytology (LC) was negative. The patient was administered GEM + nabPTX (GnP) as potential unresectable PDAC. After four courses of GnP, CA19-9 level returned to normal and FDG PET-CT showed a negative uptake; therefore, curative resection was proposed. The second SL revealed negative LC of the lesser sac, and liver lesions through indocyanine green fluorescence imaging were not diagnosed as pathological metastases. And consecutive total laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) was successfully done, resulting in a 300-mL blood loss in 450-min. The pathological diagnosis was ypT1cN0M1 stage IV with negative surgical margins. Adjuvant chemotherapy using S-1 was introduced and a 3-month recurrence-free survival has been achieved so far. Discussion: Needle-tract seeding is a rare complication of EUS-FNA for PDAC and therapeutic strategy is discussable. Recently, neoadjuvant chemotherapy was recommended for resectable PDAC requiring pathological diagnosis in Japan. It is suggesting the significance of SL and LC after EUS-FNA in PDAC.

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

Staging laparoscopy is considered useful for determining treatment plans for advanced pancreatic cancer. However, the indications for staging laparoscopy are not clear. This study aimed to evaluate the safety of staging laparoscopy and its usefulness for detecting distant metastases in patients with pancreatic cancer. A total of 146 patients with pancreatic cancer who underwent staging laparoscopy between 2013 and 2019 were analyzed. Staging laparoscopy was performed in all pancreatic cancer patients in whom surgery was considered possible. In this cohort, 42 patients (29%) were diagnosed with malignant cells on peritoneal lavage cytology, 9 (6%) had peritoneal dissemination, and 11 (8%) had liver metastases. A total of 48 (33%) had radiologically negative metastases. On a multivariate analysis, body and tail cancer [odds ratio (OR) 5.00, 95% confidence interval (CI) 2.15-11.6, p < 0.001], high CA19-9 level [OR 4.04, 95% CI 1.74-9.38, p = 0.001], and a resectability status of unresectable (OR 2.31, 95% CI 1.03-5.20, p = 0.04) were independent risk factors for radiologically negative metastases. Staging laparoscopy can be safely performed and is useful for the diagnosis of radiologically negative metastases. Staging laparoscopy should be routinely performed for the accurate diagnosis of pancreatic cancer patients before pancreatectomy and/or local treatment, such as radiotherapy.

Indication for staging laparoscopy for patients with pancreatic cancer

Indication for staging laparoscopy for patients with pancreatic cancer

English

BACKGROUND AND AIMS: Many surgeons worldwide had challenging experience of facing an unexplainable and uncertain diagnosis or staging of abdominal malignancies. Laparoscopic visualisation techniques have improved dramatically and had led to reassessment of the laparoscope for use in the staging of intraabdominal malignancies. To evaluate place of preoperative laparoscopy as an additional tool to diagnose, assess staging and operability of intraabdominal tumors. SETTINGS AND DESIGN: A prospective observational case series. MATERIALS AND METHODS: Thirty five consecutive cases undergoing preoperative staging laparoscopy from December 2008 to September 2010 were reviewed in order to determine the value of laparoscopy as a staging tool. Indications for staging laparoscopy were predominantly hepatopancreaticobiliary (45%); however, other primaries such as stomach and colon were included. RESULTS: Unnecessary laparotomies prevented in 57.14% of cases. Metastatic spread detected by laparoscopy was in 40% of cases. The sensitivity and specificity of laparoscopy in Abdominal malignancies to detect resectable disease is 65.3% and 100% respectively. CONCLUSIONS: laparoscopy is a useful preoperative staging tool and can help avoid unnecessary laparotomy for abdominal malignancy in one- half of cases.

Laparoscopic staging of intraabdominal malignancy

Laparoscopic visualization techniques have improved dramatically over the last 5 years and have led to reassessment of the laparoscope for use in the staging of intraabdominal malignancy. One hundred sixty-two consecutive cases undergoing preoperative staging laparoscopy from January 1988 to December 1993 were reviewed in order to determine the value of laparoscopy as a staging tool. Indications for staging laparoscopy were predominantly hepatopancreaticobiliary (85%); however, other primaries such as stomach and colon were included. In 36% of cases information found at laparoscopy precluded resection and prevented unnecessary laparotomy. Additional information that was felt to be helpful in planning resection was found in 30% of cases. In 12% of cases unresectability was found only at the time of laparotomy and was missed by staging laparoscopy. We conclude that laparoscopy is a useful preoperative staging tool and can help avoid unnecessary laparotomy for intraabdominal malignancy in one-third of patients.