Staging laparoscopy is mandatory for the treatment of pancreatic cancer to avoid missing radiologically negative metastases
Staging laparoscopy is mandatory for the treatment of pancreatic cancer to avoid missing radiologically negative metastases
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DOI：
10.1007/s00595-020-02121-4
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发表时间：
2020-09-08
期刊：
影响因子：
2.5
通讯作者：
Unno, Michiaki
中科院分区：
文献类型：
--
作者：
Takadate, Tatsuyuki;Morikawa, Takanori;Unno, Michiaki
目的 分期腹腔镜检查被认为有助于确定晚期胰腺癌的治疗计划。然而，腹腔镜分期的适应症尚不清楚。本研究旨在评估分期腹腔镜检查的安全性及其对于检测胰腺癌患者远处转移的有用性。方法对2013年至2019年期间接受分期腹腔镜检查的146例胰腺癌患者进行分析。对所有被认为可能进行手术的胰腺癌患者进行了分期腹腔镜检查。结果 在该队列中，42 例患者（29%）经腹腔灌洗细胞学诊断为恶性细胞，9 例（6%）有腹膜播散，11 例（8%）有肝转移。共有 48 例 (33%) 的转移灶放射学呈阴性。在多变量分析中，体癌和尾癌[比值比 (OR) 5.00，95% 置信区间 (CI) 2.15-11.6，p < 0.001]、高 CA19-9 水平 [OR 4.04，95% CI 1.74-9.38，p = 0.001]，以及不可切除状态（OR 2.31， 95% CI 1.03-5.20，p = 0.04）是放射学阴性转移的独立危险因素。结论 分期腹腔镜检查可以安全地进行，并且有助于诊断放射学阴性的转移瘤。在胰腺切除术和/或局部治疗（例如放疗）之前，应常规进行分期腹腔镜检查，以准确诊断胰腺癌患者。
Purpose Staging laparoscopy is considered useful for determining treatment plans for advanced pancreatic cancer. However, the indications for staging laparoscopy are not clear. This study aimed to evaluate the safety of staging laparoscopy and its usefulness for detecting distant metastases in patients with pancreatic cancer. Methods A total of 146 patients with pancreatic cancer who underwent staging laparoscopy between 2013 and 2019 were analyzed. Staging laparoscopy was performed in all pancreatic cancer patients in whom surgery was considered possible. Results In this cohort, 42 patients (29%) were diagnosed with malignant cells on peritoneal lavage cytology, 9 (6%) had peritoneal dissemination, and 11 (8%) had liver metastases. A total of 48 (33%) had radiologically negative metastases. On a multivariate analysis, body and tail cancer [odds ratio (OR) 5.00, 95% confidence interval (CI) 2.15-11.6,p < 0.001], high CA19-9 level [OR 4.04, 95% CI 1.74-9.38,p = 0.001], and a resectability status of unresectable (OR 2.31, 95% CI 1.03-5.20,p = 0.04) were independent risk factors for radiologically negative metastases. Conclusions Staging laparoscopy can be safely performed and is useful for the diagnosis of radiologically negative metastases. Staging laparoscopy should be routinely performed for the accurate diagnosis of pancreatic cancer patients before pancreatectomy and/or local treatment, such as radiotherapy.