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Laparoscopic Staging in Patients with Newly Diagnosed Pancreatic Cancer

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Pancreatic Cancer

Abstract

Prompt accurate staging is paramount in managing patients with newly diagnosed pancreatic cancer. Initially, diagnosis and staging are undertaken using contrast-enhanced multidetector computerized tomography (CE-MDCT) or magnetic resonance imaging (MRI), supplemented with endoscopic ultrasound in selected cases. Staging laparoscopy (SL) with or without laparoscopic ultrasound (L-LUS) has been found to detect occult disease in 13–28% of patients with pancreatic cancer who are considered potentially resectable on imaging; however, between 1% and 30% of patients thought to be resectable on SL/L-LUS have subsequently been found to have unresectable disease. The clinical utility of SL/L-LUS can be enhanced by adopting a selective approach, only undertaking SL/L-LUS when one or more criteria are present, including (1) presumed pancreatic primary >3 cm diameter, (2) lesions in the body and tail of the pancreas, (3) CA 19–9>150 kU/L (>300 when total bilirubin >35 micromol/L), and (4) platelet/lymphocyte ratio >150. The judicious use of SL/L-LUS and cross-sectional imaging are complementary; however, the advent of PET-CT may lead to improvements in the detection of small previously radiologically occult metastases and may reduce the future role of SL/L-LUS.

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Authors and Affiliations

  1. Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK

    Timothy Gilbert, Ryan Baron, Paula Ghaneh & Christopher Halloran

  2. Department of Surgery, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK

    Paula Ghaneh

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  1. Timothy Gilbert
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  2. Ryan Baron
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  3. Paula Ghaneh
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  4. Christopher Halloran
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Correspondence to Timothy Gilbert .

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Editors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    John P. Neoptolemos

  2. Division of Research Department of Surgery and Genomic Sciences and Precision Medicine Center (GSPMC), Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Raul Urrutia

  3. Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA

    James L. Abbruzzese

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler

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  1. Duke University Medical Center, Durham, NC, USA

    James L. Abbruzzese

  2. Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Raul A. Urrutia

  3. Division of Surgery and Oncology, University of Liverpool, Daulby Street, Liverpool, UK

    John Neoptolemos

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler

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Gilbert, T., Baron, R., Ghaneh, P., Halloran, C. (2018). Laparoscopic Staging in Patients with Newly Diagnosed Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7193-0_80

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