Staging laparoscopy to detect occult metastases in localized pancreatic cancer: global survey among nine international societies.
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Stoop Thomas F, Lutchman Kishan R D, Theijse Rutger T, Larsson Patrik, Oba Atsushi, Groot Koerkamp Bas, van Eijck Casper H J, Wolfgang Christopher L, Rangelova Elena, Marchegiani Giovanni, Endo Itaru, Jang Jin-Young, Primrose John M, Ramia Jose M, Katz Matthew H G, Abu Hilal Mohammed, Ghorbani Poya, Shrikhande Shailesh V, Hackert Thilo, Nealon William H, Truty Mark J, Del Chiaro Marco, Besselink Marc G, European Pancreas Club, Pancreas Club, European Consortium on Minimally Invasive Pancreatic Surgery, European Society of Surgical Oncology, Japanese Society of Hepato-Biliary-Pancreatic Surgery, International Collaboration on Advanced Pancreatic Cancer, European-African Hepato-Pancreato-Biliary Association, Asian Pacific Hepato-Pancreato-Biliary Association, and International Hepato-Pancreato-Biliary Association
Аннотация
METHODS: An online survey was sent to members of nine international societies and working groups. Information was obtained about SL use, indications SL and adjunct diagnostic modalities across four clinical scenarios.
RESULTS: Among 617 responding surgeons (76 countries, six continents), 82% used SL which varied between regions (Americas 90%, Asia 85%, Oceania 81%, Europe 76%, Africa 59%; P < 0.050). Most perform SL during the same session as the scheduled laparotomy (63-79%). A SL was mainly performed at the time of upfront surgery (71%), after (60%) or before (37%) neoadjuvant/induction therapy, and before radiotherapy (31%). SL was mainly performed in selected patients, either based on indeterminate/suspicious lesions on cross-sectional imaging (78-87%), resectability status (54-64%), and/or elevated CA19-9 level (60-69%). Most common used adjuncts were cytological lavage (37-55%) and intra-abdominal liver ultrasonography (36-50%).
CONCLUSION: Despite considerable global variability, SL is widely used to detect occult metastases in pancreatic cancer, mainly in high-risk patients and often during the scheduled laparotomy. The observed variability highlights the need for more evidence leading to stronger guideline recommendations.