Aim: The study aimed to determine the additional value of staging laparoscopy in patients with pancreatic cancer deemed potentially resectable based on computed tomography imaging. Methods: A systematic literature search was performed using MEDLINE and the Cochrane Register of Controlled Trials (January 1995 to June 2017). Primary outcome measures were the overall yield and sensitivity to detect non-resectable disease. Quality of studies was assessed with the Newcastle-Ottawa Scale. Results: From 156 records, 15 studies including 2,776 patients met the inclusion criteria. In 12 studies, reporting outcomes on 1,756 patients with resectable disease after standard imaging, 350 (20%, range 14–38%) cases of non-resectable cancer were detected with staging laparoscopy. In 3 studies on 242 patients with locally advanced disease after standard imaging, staging laparoscopy detected metastases in 86 patients (36%). The failure rate of staging laparoscopy to detect non-resectable disease was 5% (64 of 1,406). Conclusion: Staging laparoscopy reduces the non-therapeutic laparotomy rate, and in locally advanced or borderline resectable disease, staging laparoscopy could more accurately select patients for neoadjuvant protocols.

Keywords:
Staging laparoscopy, Pancreatic cancer, Computed tomography, Meta-analysis
1.
Merchant NB, Conlon KC: Laparoscopic evaluation in pancreatic cancer. Semin Surg Oncol 1998; 15: 155–165.
2.
Siegel RL, Miller KD, Jemal A: Cancer statistics, 2016. CA Cancer J Clin 2016; 66: 7–30.
3.
Ryan DP, Hong TS, Bardeesy N: Pancreatic adenocarcinoma. N Engl J Med 2014; 371: 1039–1049.
4.
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A: AJCC Cancer Staging Manual, ed 7. New York, Springer, 2010.
5.
National Comprehensive Cancer Network (2013). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Pancreatic Adenocarcinoma (Version 1.2013). http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf (accessed November 2, 2016).
6.
Von Hoff DD, Evans DB, Hruban RH: Pancreatic Cancer, ed 1. Sudbury, Jones & Bartlett Learning, 2005.
7.
Conlon KC, Dougherty E, Klimstra DS, Coit DG, Turnbull AD, Brennan MF: The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg 1996; 223: 134–140.
8.
Conlon KC, Minnard E: The value of laparoscopic staging in upper gastrointestinal malignancy. Oncologist 1997; 2: 10–17.
9.
Freeny PC: Pancreatic carcinoma: imaging update 2001. Dig Dis 2001; 19: 37–46.
10.
Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al: The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed October 1, 2016).
11.
Allen VB, Gurusamy KS, Takwoingi Y, Kalia A, Davidson BR: Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 2013; 11:CD009323.
12.
Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M, et al: Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the international study group for pancreatic surgery (ISGPS). Surgery. 2014; 156: 1–14.
13.
Pingpank JF, Hoffman JP, Ross EA, Cooper HS, Meropol NJ, Freedman G, Pinover WH, LeVoyer TE, Sasson AR, Eisenberg BL: Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas. J Gastrointest Surg 2001; 5: 121–130.
14.
Laurence JM, Tran PD, Morarji K, Eslick GD, Lam VW, Sandroussi C: A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer. J Gastrointest Surg 2011; 15: 2059–2069.
15.
Assifi MM, Lu X, Eibl G, Reber HA, Li G, Hines OJ: Neoadjuvant therapy in pancreatic adenocarcinoma: a meta-analysis of phase II trials. Surgery 2011; 150: 466–473.
16.
Slaar A, Eshuis WJ, van der Gaag NA, Nio CY, Busch OR, van Gulik TM, et al: Predicting distant metastasis in patients with suspected pancreatic and periampullary tumors for selective use of staging laparoscopy. World J Surg 2011; 35: 2528–2534.
17.
Morris S, Gurusamy KS, Sheringham J, Davidson BR: Cost-effectiveness of diagnostic laparoscopy for assessing resectability in pancreatic and periampullary cancer. BMC Gastroenterol 2015; 15: 44.
18.
Jayakrishnan TT, Nadeem H, Groeschl RT, George B, Thomas JP, Ritch PS, et al. Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument. HPB (Oxford) 2015; 17: 131–139.
19.
Ellsmere J, Mortele K, Sahani D, Maher M, Cantisani V, Wells W, Brooks D, Rattner D: Does multidetector-row CT eliminate the role of diagnostic laparoscopy in assessing the resectability of pancreatic head adenocarcinoma? Surg Endosc 2005; 19: 369–373.
20.
Contreras CM, Stanelle EJ, Mansour J, Hinshaw JL, Rikkers LF, Rettammel R, Mahvi DM, Cho CS, Weber SM: Staging laparoscopy enhances the detection of occult metastases in patients with pancreatic adenocarcinoma. J Surg Oncol 2009; 100: 663–669.
21.
Mayo SC, Austin DF, Sheppard BC, Mori M, Shipley DK, Billingsley KG: Evolving preoperative evaluation of patients with pancreatic cancer: does laparoscopy have a role in the current era? J Am Coll Surg 2009; 208: 87–95.
22.
White R, Winston C, Gonen M, D'Angelica M, Jarnagin W, Fong Y, Conlon K, Brennan M, Allen P: Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg 2008; 206: 445–450.
23.
Jimenez RE, Warshaw AL, Rattner DW, Willett CG, McGrath D, Fernandez-del Castillo C: Impact of laparoscopic staging in the treatment of pancreatic cancer. Arch Surg. 2000; 135: 409–414.
24.
Reddy KR, Levi J, Livingstone A, Jeffers L, Molina E, Kligerman S, Bernstein D, Kodali VP, Schiff ER: Experience with staging laparoscopy in pancreatic malignancy. Gastrointest Endosc 1999; 49(4 pt 1):498–503.
25.
Andrén-Sandberg A, Lindberg CG, Lundstedt C, Ihse I: Computed tomography and laparoscopy in the assessment of the patient with pancreatic cancer. J Am Coll Surg. 1998; 186: 35–40.
26.
Fernandez-del Castillo C, Rattner DW, Warshaw AL: Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg 1995; 82: 1127–1129.
27.
Lavonius MI, Laine S, Salo S, Sonninen P, Ovaska J: Role of laparoscopy and laparoscopic ultrasound in staging of pancreatic tumours. Ann Chir Gynaecol 2001; 90: 252–255.
28.
Awad SS, Colletti L, Mulholland M, Knol J, Rothman ED, Scheiman J, Eckhauser FE: Multimodality staging optimizes resectability in patients with pancreatic and ampullary cancer. Am Surg 1997; 63: 634–638.
29.
Schneider AR, Adamek HE, Layer G, Riemann JF, Arnold JC: Staging of abdominal metastases in pancreatic carcinoma by diagnostic laparoscopy and magnetic resonance imaging. Z Gastroenterol 2003; 41: 697–702.
30.
Arnold JC, Neubauer HJ, Zopf T, Schneider A, Benz C, Adamek HE, Riemann JF: Improved tumour staging by diagnostic laparoscopy. Z Gastroenterol 1999; 37: 483–488.
31.
Liu RC, Traverso LW: Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Surg Endosc 2005; 19: 638–642.
32.
Shoup M, Winston C, Brennan MF, Bassman D, Conlon KC: Is there a role for staging laparoscopy in patients with locally advanced, unresectable pancreatic adenocarcinoma? J Gastrointest Surg 2004; 8: 1068–1071.
33.
Morak MJ, Hermans JJ, Smeenk HG, Renders WM, Nuyttens JJ, Kazemier G, van Eijck CH: Staging for locally advanced pancreatic cancer. Eur J Surg Oncol 2009; 35: 963–968.
34.
Kim HW, Lee JC, Paik KH, Kang J, Kim YH, Yoon YS, et al: Adjunctive role of preoperative liver magnetic resonance imaging for potentially resectable pancreatic cancer. Surgery 2017; 161: 1579–1587.
35.
Van der Geest LGM, Lemmens VEPP, de Hingh IHJT, van Laarhoven CJHM, Bollen TL, Nio CY, et al: Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer. Br J Surg 2017; 104: 1568–1577.
36.
De Rosa A, Cameron IC, Gomez D: Indications for staging laparoscopy in pancreatic cancer. HPB (Oxford) 2016; 18: 13–20.
37.
Peng JS, Mino J, Monteiro R, Morris-Stiff G, Ali NS, Wey J, et al: Diagnostic laparoscopy prior to neoadjuvant therapy in pancreatic cancer is high yield: an analysis of outcomes and costs. J Gastrointest Surg 2017; 21: 1420–1427.
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2018
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