Predicting Distant Metastasis in Patients With Suspected Pancreatic and Periampullary Tumors for Selective Use of Staging Laparoscopy

• Published in: World journal of surgery Vol. 35; no. 11; pp. 2528 - 2534
• Main Authors: Slaar, Annelie, Eshuis, Wietse J., van der Gaag, Niels A., Nio, C. Yung, Busch, Olivier R. C., van Gulik, Thomas M., Reitsma, Johannes B., Gouma, Dirk J.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.11.2011; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - complications; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Ampulla of Vater - pathology; Ampulla of Vater - surgery; Biological and medical sciences; Cardiac Surgery; Common Bile Duct Neoplasms - complications; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; Digestive system. Abdomen; Distant Metastasis; Endoscopy; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; General Surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Jaundice - etiology; Laparoscopy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Periampullary Tumor; Prognosis; Prospective Studies; Receiver Operating Characteristic; Risk Assessment; Staging Laparoscopy; Surgery; Thoracic Surgery; Tumors; Unresectable Disease; Vascular Surgery; Weight Loss; Distant Metastasis; Periampullary Tumor; Unresectable Disease; Staging Laparoscopy; Receiver Operating Characteristic; Human; Pancreatic tumor; Staging; Use; Stage classification; Patient; Laparoscopy; Malignant tumor; Metastasis; Medicine; Treatment; Surgery; Digestive diseases; Periampullary; Diagnosis; Endoscopy; Cancer; Pancreatic disease
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-011-1204-6

Background In patients with pancreatic or periampullary tumor, staging laparoscopy (SL) can detect metastases that are occult on computed tomography (CT), thereby precluding nontherapeutic laparotomy. Routine SL is not advocated, but some studies suggest its selective use. The aim of this study was to identify patients at risk for metastasis in whom SL could be beneficial. Methods A consecutive series of patients who underwent laparotomy for a suspected pancreatic or periampullary tumor were analyzed. We included patients with a suspected resectable solid lesion and a recent high-quality CT scan. Patients with and without an intraoperatively encountered metastasis were compared. Regression analysis was performed to examine the association between various predictors and metastasis. Results Data from 385 patients (mean age 63, 41% women) were analyzed. Distant metastasis was encountered in 79 patients (21%). Logistic regression analysis revealed the following key predictors for metastasis: tumor size on CT scan [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.16–1.76 per millimeter increase], weight loss (OR 1.28, 95% CI 1.01–1.63 per doubling the kilograms), and history of jaundice (OR 2.36, 95% CI 0.79–7.06). In patients with a tumor ≥3 cm and severe weight loss (≥10 kg) and in patients with a tumor ≥4 cm and moderate weight loss (≥5 kg), the proportion of patients with metastasis was >40%. Conclusions In patients with a suspected pancreatic or periampullary tumor, the tumor size, weight loss, and jaundice are key predictors of metastasis at exploration. SL might be beneficial in patients with a tumor ≥3 cm and severe weight loss and in those with a tumor ≥4 cm and moderate weight loss.