# The role of staging laparoscopy before therapy in patients with pancreatic ductal adenocarcinoma: a real-world, single-center experience

## TL;DR

This study shows that staging laparoscopy helps accurately detect hidden metastases in pancreatic cancer patients, improving treatment decisions.

## Contribution

The study identifies CEA positivity and CA19-9 ≥ 150 U/mL as predictors of occult metastasis in pancreatic cancer patients undergoing staging laparoscopy.

## Key findings

- Staging laparoscopy revealed distant metastasis in 23.5% of patients with no radiological evidence of metastasis.
- CEA positivity and CA19-9 ≥ 150 U/mL were independently associated with occult metastasis.
- Staging laparoscopy was safe with no morbidity or mortality observed in the study.

## Abstract

Staging laparoscopy (SL) for pancreatic ductal adenocarcinoma (PDAC) is considered useful in improving the accuracy of staging and resectability. However, currently, there are no standard criteria for selecting patients who may benefit from SL prior to determining the appropriate treatment. In this report, we aimed to determine the role of SL before therapy in patients with PDAC.

This study was a single-center, prospective cohort study comprising patients with PDAC at Iwate Medical University Hospital during the period from November 2021 to June 2025. SL was performed in all patients with PDAC with no radiological distant metastasis before they underwent pancreatic resection or chemotherapy or chemoradiotherapy. The baseline characteristics, operative outcomes, changes of resectability status, complete resection rate and mid-term survival were examined.

102 patients were finally included in the present study. Before SL, according to resectability status, 45 patients (44.1%) were classified as resectable (R), 36 (35.0%) as borderline resectable (BR), and 21 (20.6%) as unresectable locally advanced (UR-LA). SL revealed distant metastasis in 24 (23.5%) patients. The univariate analysis revealed that the factors of CEA positive and CA19-9 ≥ 150, U/mL were associated with a significantly higher risk of occult metastasis. The multivariate analysis revealed that having a CEA positive and CA19-9 ≥ 150, U/mL were the only factors that were independently associated with occult metastasis. For patients with R PDAC before SL, distant metastasis was found after SL in 17.8% of patients. Even in cases where none of the tumor markers were elevated, one case was found to have distant metastasis after SL. There was no morbidity and mortality in this case series. In the intention-to-treat population, the median overall survival (OS) were not reached [95% CI: 22.0 months–not estimable (NE)]. The median DFS was 22.0 months (95% CI: 15.0 months–27.0 months). Of the patients with UR-LA PDAC, despite stage migration, no improvement in OS was observed after SL.

SL is safe and effective in determining accurate staging, which may allow for more appropriate treatment. Therefore, SL is actively recommended for patients with R PDAC or BR PDAC who are planning to undergo complete resection shortly to avoid unnecessary surgical exploration, especially those CEA positive or with CA19-9 ≥ 150 U/mL.