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Staging Pancreatic Cancer Early With Minimally Invasive Surgery Shows Positive Results in Patient Prognosis

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 A study published in the Journal of the American College of Surgeons reveals that performing a minor surgical procedure on patients newly diagnosed with pancreatic cancer helps to identify cancer spread early and determine the stage of cancer. The researchers add that the surgery ideally should be performed before the patient begins chemotherapy.

“This is an important study because it supports that staging laparoscopy may help with determining a patient’s prognosis and better inform treatment so that patients avoid unhelpful or potentially harmful surgical therapy,” said Mark Truty, MD, surgical oncologist at the Mayo Clinic Comprehensive Cancer Center, who led this research. “Pancreatic cancer is the least survivable of all cancers, and it spreads fast. So, to have this information if cancer has spread will benefit patients and help clinicians determine the right treatment for the patient as soon as possible.”

The minimally invasive surgical procedure is called a staging laparoscopy and is when a surgeon inserts a light and a camera (laparoscope) into the abdomen through small, thin slits to visually see if cancer has spread within the abdominal cavity. The surgeon also may combine this with peritoneal washings, where fluid is inserted into the abdominal cavity and then removed and evaluated under a microscope for cancer cells.

During the five-year study, the authors evaluated data from more than 1,000 patients, and the research showed that 1 in 5 patients who underwent a staging laparoscopy for pancreatic cancer had cancer that spread in the liver or the lining of the abdomen (peritoneum). 

In addition, the researchers found a variety of factors that identified which patients were more likely to have cancer spread. These factors included the patient’s age, the location of the tumor and tumor markers (CA 19-9) in the blood. The researchers say that the more risk factors that are present, the higher the risk of finding cancer spread.

“Based on these results, we recommend that staging laparoscopy be performed before starting chemotherapy in the majority of patients who have pancreatic cancer and are being considered for surgery,” said first author Hallbera Gudmundsdottir, MD, general surgery resident and Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Scholar. The findings on staging laparoscopy can help guide what treatment will be the best option for each patient, such as surgical removal or chemotherapy.

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