TUESDAY, Aug. 15, 2023 (HealthDay News) — For patients with pancreatic ductal adenocarcinoma (PDAC), the rate of positive laparoscopy (PL) is high and is associated with younger age, indeterminate extrapancreatic lesions on preoperative imaging, and body/tail tumor location, according to a study published in the July issue of the Journal of the American College of Surgeons.

Hallbera Gudmundsdottir, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the diagnostic yield of staging laparoscopy (SL) and identified factors associated with increased risk of PL in the modern era among 1,004 patients with localized PDAC who underwent SL from 2017 to 2021.

The researchers found that 18 percent of the patients had PL due to gross metastases and/or positive cytology. The rates of PL were lower for patients who had neoadjuvant chemotherapy prior to laparoscopy (14 versus 22 percent). Twenty-three percent of patients had PL when the analysis was restricted to the 419 chemotherapy-naive patients who had concurrent peritoneal lavage performed. In multivariable analysis, there were associations seen for PL with younger age (<60 years), indeterminate extrapancreatic lesions on preoperative imaging, body/tail tumor location, larger tumor size, and elevated serum CA 19-9. The rate of PL ranged among patients with no indeterminate extrapancreatic lesions on preoperative imaging, from 1.6 percent for those with no risk factors to 42 percent in young patients with large body/tail tumors and elevated serum CA 19-9.

“Based on these results, we recommend that staging laparoscopy be performed before starting chemotherapy in the majority of patients who have pancreatic cancer and are being considered for surgery,” Gudmundsdottir said in a statement.

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