Performing a minimally invasive staging laparoscopy on patients with newly diagnosed pancreatic cancer may help determine the stage and identify cancer metastases early, according to a novel study published by Gudmundsdottir et al in the Journal of the American College of Surgeons. The new findings suggested that the procedure should ideally be performed prior to the initiation of chemotherapy.
Background
A staging laparoscopy involves the insertion of a laparoscope into the abdomen through small, thin slits to visually see if the cancer has metastasized within the abdominal cavity. Surgeons may combine this procedure with peritoneal washings—where fluid is inserted into the abdominal cavity and then removed and evaluated under a microscope for cancer cells.
"This is an important study because it supports that staging laparoscopy may help with determining a patient's prognosis and better inform treatment so that patients avoid unhelpful or potentially harmful surgical therapy," highlighted senior study author Mark Truty, MD, MSc, FACS, Professor of Surgery and a surgical oncologist in the Division of Hepatobiliary and Pancreas Surgery at the Mayo Clinic Comprehensive Cancer Center. "Pancreatic cancer is the least survivable of all cancers, and it spreads fast. So, to have this information if cancer has spread will benefit patients and help clinicians determine the right treatment for the patient as soon as possible,” he emphasized.
Study Methods and Results
In the new study, the investigators evaluated the data of over 1,000 patients with pancreatic cancer. After a follow-up of 5 years, they found that 20% of the patients who underwent a staging laparoscopy had cancer that metastasized to the liver or the peritoneum.
In addition, the investigators discovered a variety of factors that identified which patients were more likely to experience cancer metastases—including age, location of the tumor, and tumor markers in the blood. When more risk factors were present, the investigators noted that patients may have had a higher risk of cancer metastasis.
Conclusions
"Based on these results, we recommend that staging laparoscopy be performed before starting chemotherapy in the majority of patients who have pancreatic cancer and are being considered for surgery," concluded lead study author Hallbera Gudmundsdottir, MD, a general surgery resident at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
The investigators hope their new findings can help guide what treatments will be optimal for each patient with pancreatic cancer.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
