Staging laparoscopy to detect occult metastases in localized pancreatic cancer: global survey among nine international societies

Abstract

Background: staging laparoscopy (SL) is performed to detect occult metastases in patients with localized pancreatic cancer. However, current guideline recommendations vary widely on routinely performing SL. This global survey investigated use and indications of SL. 

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.

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