The Role of Routine Staging Laparoscopy for Pancreatic Adenocarcinoma in Underserved Populations: A 14-Year Experience at a Safety-Net Hospital

IF 1.9 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2026-09-01 Epub Date: 2026-06-07 DOI:10.1002/jso.70299

David M. Holmes, Jose Euberto Mendez Reyes, Cary Hsu, Eric J. Silberfein

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引用次数: 0

Abstract

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.

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腹腔镜常规分期治疗胰腺腺癌在医疗服务不足人群中的作用：一家安全网医院14年的经验

背景：胰导管腺癌（PDAC）的腹腔镜（SL）分期尚无共识指南，现有数据主要反映了参保转诊人群。常规SL尚未在缺乏服务的患者群体中进行研究，这些患者面临癌症诊断和治疗的差异。我们在一家城市安全网医院评估了SL对可能可手术的PDAC的效用，并评估了其与生存率的关系。方法：2011年5月至2025年5月，对所有接受SL治疗的可切除PDAC患者进行单机构回顾性研究。主要观察指标为隐匿性转移的检测。使用多变量逻辑回归评估相关因素。生存率分析采用Kaplan-Meier方法和log-rank检验。结果：52例患者接受了SL， 18例（35%）接受了治愈目的手术。中位年龄为58岁，87%为非白人，40%为非英语，89%为急诊。SL在12例（23.1%）患者中发现了隐匿性转移性疾病，其中5例（41.7%）仅通过细胞学诊断。没有临床病理因素与隐匿性转移有关。有隐匿性转移的患者中位总生存期为9.5个月，而无隐匿性转移的患者中位总生存期为35.7个月(p)。结论：常规SL经常抢了患者的风头，通常仅通过细胞学检查，因此避免了非治疗性剖腹手术，并支持考虑在服务不足的PDAC人群中更常规地使用它。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.