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Objective: To evaluate the efficacy of staging laparoscopy for detection of peritoneal metastases in pancreatic cancer in the age of high-resolution staging CT scans.
Design: A retrospective cohort study evaluating patients who underwent operative treatment for radiographic stage I-III pancreatic cancer between 7/2003 and 10/2012. The study population included pancreatic carcinoma, ampullary carcinoma, and invasive pancreatic cystic neoplasms. Median follow-up was 12.1 months.
Setting: An academic tertiary care medical center.
Patients: Of 274 patients, who met inclusion criteria, 136 (50%) underwent staging laparoscopy.
Main Outcome Measure: Sensitivity and false-negative rate of staging laparoscopy for pancreatic cancer.
Results: All patients were assessed by multidetector CT scan for staging. Staging laparoscopy identified radiographically occult distant metastases in 2% (3/136) of patients. However, subsequent laparotomy identified additional 9% (12/136) harboring distant metastases in regions requiring mobilization of organs for visualization. Specifically, in 83% (10/12) the missed metastases were localized on the posterior liver surface, para-duodenal retroperitoneum, or lesser sac. Similar results were obtained for initial staging laparotomy, which identified radiographically occult distant disease in 11% (15/138) of patients. Within 6 months after the operation, an additional 6% (15/257) develop peritoneal or subcapsular liver metastases; disease that potentially could have been diagnosed at the time of operation.
Conclusions: Despite of the availability of high-resolution CT scans, occult distant metastases can still be found in 11% of patients. In the absence of reliable risk factors to predict distant metastases, staging laparoscopy should be offered to all patients with radiographically localized disease. However, the results favor extended laparoscopic staging with evaluation of the posterior liver surface, mobilization of the duodenum, and imaging of the lesser sac.