Recommended Citation
Brandt M, Levesque A, Kirschner R, Bellini G, Papenfuss W, Wankowski D. Staging Laparoscopy for Pancreatic Ductal Adenocarcinoma: Experience from a Large Quaternary Care System. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Detection of radiographically occult metastatic disease (ROMD) in pancreatic ductal adenocarcinoma (PDAC) remains vital for staging. There is no standardized approach, but borderline resectable or locally advanced disease, CA 19-9 > 394, location in the pancreatic body or tail, and no neoadjuvant therapy are predictive of ROMD and often used to select patients for staging laparoscopy. Peritoneal washings have been used at the time of laparoscopy to further detect occult disease, with positive cytology considered by NCCN guidelines to be metastatic (M1) disease.
Purpose:
We sought to study characteristics of patients undergoing laparoscopy with or without washings to inform a future protocol at our institution.
Methods:
This was a single-institution retrospective chart review of all adult patients (>18) undergoing staging laparoscopy for known or suspected PDAC (ICD C25-9) from Jan 1, 2020 – Dec 31, 2024. Patients with known metastatic disease were excluded. Descriptive statistics were calculated. Unpaired t-tests were used for normally distributed continuous variables, and Mann-Whitney u-test for nonparametric data. Fischer’s exact test was used for comparison of categorical values with small sample sizes.
Results:
98 patients underwent staging laparoscopy for PDAC. Washings were performed in 55/98 patients (56%). Preoperative characteristics related to ROMD identified at laparoscopy were analyzed. Positive or atypical cytology was found in 7/55 cases (12.7%). One patient (1/55) had positive washings with no gross metastatic disease. In this sample, median CA 19-9, BMI, and tumor location were not associated with ROMD at laparoscopy. Fifty percent (10/20) of patients with ROMD had upfront resectable disease vs. only 41% (32/78) in the no metastasis group (p = 0.01). Cytology results were associated with diagnosis of biopsy proven metastatic disease at laparoscopy (p = 0.003).
Conclusion:
Staging laparoscopy remains crucial to the workup for PDAC to inform treatment decisions and set patient expectations, particularly in the setting of routine neoadjuvant treatment. In our sample, many factors typically associated with ROMD were not significant, and an unusually high proportion of resectable patients presented with occult metastatic disease. This suggests the need to consider routine staging laparoscopy, and further study is indicated to determine the role of washing.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
Staging Laparoscopy for Pancreatic Ductal Adenocarcinoma: Experience from a Large Quaternary Care System
Background/Significance:
Detection of radiographically occult metastatic disease (ROMD) in pancreatic ductal adenocarcinoma (PDAC) remains vital for staging. There is no standardized approach, but borderline resectable or locally advanced disease, CA 19-9 > 394, location in the pancreatic body or tail, and no neoadjuvant therapy are predictive of ROMD and often used to select patients for staging laparoscopy. Peritoneal washings have been used at the time of laparoscopy to further detect occult disease, with positive cytology considered by NCCN guidelines to be metastatic (M1) disease.
Purpose:
We sought to study characteristics of patients undergoing laparoscopy with or without washings to inform a future protocol at our institution.
Methods:
This was a single-institution retrospective chart review of all adult patients (>18) undergoing staging laparoscopy for known or suspected PDAC (ICD C25-9) from Jan 1, 2020 – Dec 31, 2024. Patients with known metastatic disease were excluded. Descriptive statistics were calculated. Unpaired t-tests were used for normally distributed continuous variables, and Mann-Whitney u-test for nonparametric data. Fischer’s exact test was used for comparison of categorical values with small sample sizes.
Results:
98 patients underwent staging laparoscopy for PDAC. Washings were performed in 55/98 patients (56%). Preoperative characteristics related to ROMD identified at laparoscopy were analyzed. Positive or atypical cytology was found in 7/55 cases (12.7%). One patient (1/55) had positive washings with no gross metastatic disease. In this sample, median CA 19-9, BMI, and tumor location were not associated with ROMD at laparoscopy. Fifty percent (10/20) of patients with ROMD had upfront resectable disease vs. only 41% (32/78) in the no metastasis group (p = 0.01). Cytology results were associated with diagnosis of biopsy proven metastatic disease at laparoscopy (p = 0.003).
Conclusion:
Staging laparoscopy remains crucial to the workup for PDAC to inform treatment decisions and set patient expectations, particularly in the setting of routine neoadjuvant treatment. In our sample, many factors typically associated with ROMD were not significant, and an unusually high proportion of resectable patients presented with occult metastatic disease. This suggests the need to consider routine staging laparoscopy, and further study is indicated to determine the role of washing.
Affiliations
Aurora St. Luke's Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center