Takanori Morikawa, MD, PhD, Masaharu Ishida, MD, PhD, Hideo Ohtsuka, MD, PhD, Takeshi Aoki, MD, PhD, Simpei Maeda, MD, PhD, Kyouhei Ariake, MD, PhD, Kunihiro Masuda, MD, PhD, Koji Fukase, MD, PhD, Masamichi Mizuma, MD, PhD, Naoaki Sakata, MD, PhD, Kei Nakagawa, MD, PhD, Hiroki Hayashi, MD, PhD, Fuyuhiko Motoi, MD, PhD, Takeshi Naitoh, MD, PhD, FACS, Michiaki Unno, MD, PhD. Department of surgery, Tohoku University Graduate School of Medicine
It is hard to decide therapeutic strategy for advanced pancreatic cancer, especially in borderline resectable cases, because of the difficulty to apply the surgical approach and to confirm clinical stage exactly. Multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have improved staging accuracy of advanced pancreatic cancers, however, precise evaluation using these diagnostic imaging was limited. Staging laparoscopy (SL) is one of the useful diagnostic methods and could detect minute liver and peritoneal metastases which would not be delineated by MDCT, MRI, and PET. Therefore, we recently introduced SL before surgical treatment or chemotherapy in order to evaluate clinical stage of advanced pancreatic cancer.
The aim of this study is to evaluate the feasibility and efficacy of SL as a diagnostic modality for patients with advanced pancreatic cancer.
[Patients and Methods]
In our institution, the indication for SL was pancreatic cancer which abutted to major artery, that is celiac artery, common hepatic artery, splenic artery, and superior mesenteric artery, or were suspected to develop to micro liver and/or peritoneal metastases. We reviewed clinical records of patients who underwent SL for advanced pancreatic cancer, and clinicopathological findings, surgical outcomes, and diagnostic accuracy were retrospectively analyzed.
From July 2010 to June 2015, 29 patients (M:F = 13:16) underwent SL. Average age was 62.7 ± 10.2 years old and mean tumor diameter was 37.6 ± 15.6 mm. Nineteen patients had pancreas head carcinoma and 27 patients were preoperatively diagnosed as clinical stage III. Mean operation time was 62.7 ± 10.2 min and intraoperative blood loss was 3.2 ± 4.7 g. Median postoperative hospital stay was 5(2-99)days. Only one patient (3.4%) experienced postoperative complication and underwent reoperation due to perforation of the small intestine, and the other 28 cases discharged uneventfully. Twelve patients diagnosed unresectable using SL because of distant metastases, and three patients diagnosed unresectable due to tumor invasion to major artery. Remaining 14 patients underwent laparotomy and palliative operation was performed in two patients due to liver metastasis (n=1) and carcinomatous peritonitis (n=1). Thereby, sensitivity and specificity of SL were calculated to be 85.7% and 100%, respectively.
SL is a safe and feasible approach and can prevent unnecessary laparotomy. It is helpful to use SL as a diagnostic modality to determine treatment strategy in case of borderline resectable pancreatic cancer.