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Role of staging laparoscopy in the management of Pancreatic Duct Carcinoma (PDAC): Single‐center experience from a tertiary hospital in Brazil
Author(s) -
de Jesus Victor Hugo Fonseca,
da Costa Junior Wilson Luiz,
de Miranda Marques Tomás Mansur Duarte,
Diniz Alessandro Landskron,
de Castro Ribeiro Héber Salvador,
de Godoy André Luis,
de Farias Igor Correia,
Coimbra Felipe José Fernandez
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25024
Subject(s) - medicine , occult , laparoscopy , odds ratio , pancreatectomy , radiology , univariate analysis , oncology , surgery , multivariate analysis , pancreas , general surgery , pathology , alternative medicine
Background Proper staging is critical to the management of pancreatic ductal carcinoma (PDAC). Laparoscopy has been used to stage patients without gross metastatic disease with variable success. Objectives We aimed to identify the frequency of patients diagnosed by laparoscopy with occult metastatic disease. Also, we looked for variables related to a higher chance of occult metastasis. Methods Patients with PDAC submitted to staging laparoscopy either immediately before pancreatectomy or as a separate procedure between January 2010 and December 2016 were included. None presented gross metastatic disease at initial staging. We used logistic regression to search for variables associated with metastatic disease. Results The study population consisted of 63 patients. Among all patients, nine (16.7%) had occult metastases at laparoscopy. Unresectable tumor (Odds ratio = 18.0, P = 0.03), increasing tumor size (Odds ratio = 1.36, P = 0.01), and abdominal pain (Odds ratio = 5.6, P = 0.04) significantly predicted the risk of occult metastases in univariate analysis. In multivariate analysis, only tumor size predicted the risk of occult metastases. Conclusion Laparoscopy remains a valuable tool in PDAC staging. Patients with either large or unresectable tumors, or presenting with abdominal pain present the highest risk for occult intra‐abdominal metastases.