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The Role of Routine Staging Laparoscopy for Pancreatic Adenocarcinoma in Underserved Populations: A 14-Year
David M Holmes1, Jose Euberto Mendez Reyes1, Cary Hsu1
1Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Background:
There are no consensus guidelines for staging laparoscopy (SL) in pancreatic ductal adenocarcinoma (PDAC) and existing data largely reflect insured referral populations. Routine SL has not been studied in underserved patient populations who face disparities in cancer diagnosis and treatment. We evaluated the utility of SL for potentially operable PDAC at an urban safety-net hospital and assessed its association with survival.
Methods:
A single-institution retrospective review was performed of all patients undergoing SL for potentially resectable PDAC (May 2011-May 2025). The primary outcome was detection of occult metastasis. Associated factors were assessed using multivariable logistic regression. Survival was analyzed using Kaplan-Meier methods and log-rank tests.
Results:
Fifty-two patients underwent SL and 18 (35%) received curative-intent surgery. Median age was 58 years, 87% were non-White, 40% non-English-speaking, and 89% presented emergently. SL identified occult metastatic disease in 12 patients (23.1%), including five (41.7%) identified by cytology alone. No clinicopathologic factors were associated with occult metastasis. Median overall survival was 9.5 months with occult metastasis versus 35.7 months without (p < 0.001), and 102.5 months after curative-intent surgery versus 17.8 months without resection (p < 0.001).
Conclusions:
Routine SL frequently upstaged patients, often by cytology alone, thereby avoiding non-therapeutic laparotomy and supporting consideration of its more routine use in underserved PDAC populations.