Pre-Chemo Laparoscopy Can Help Determine Pancreatic Cancer Treatment

Laparoscopy (a minor surgical procedure) soon after a pancreatic cancer diagnosis can help medical professionals to examine the stage and severity before prescribing chemotherapy.

“The benefit of this procedure done early (before starting any chemotherapy) is that it can accurately stage patients to determine if surgery (or subsequent radiation) will be a beneficial treatment. If cancer is found, then patients can then be more appropriately counseled for specific treatments and any additional cancer that is found can be sent for genomic analysis. If cancer is not found, then we can be more certain that surgery may offer more long-lasting benefit for these patients,” explained Dr. Mark Truty, surgical oncologist at the Mayo Clinic Comprehensive Cancer Center, in a recent interview with CURE®.

A staging laparoscopy is when a surgeons put a cameras and light into the abdomen, inserted through small slits, to examine cancer spread within the abdominal cavity, according to the study. Another component can also occur, called peritoneal washings, where, “fluid is inserted into the abdominal cavity and then removed and evaluated under a microscope for cancer cells,” according to a recent press release from the Mayo Clinic.

Researchers concluded that receiving a laparoscopy is safe, as complications tend to be minor when it comes to the procedure.

“We evaluated complications associated with this procedure and the complication rate was very low (1%) thus it is a very safe procedure overall,” explained Truty.

The study lasted for five years, and 1,000 patients were evaluated. “All of these patients had pancreatic cancer that was presumably non-metastatic (no evidence of spread) on their initial imaging. This is the group that this procedure is most beneficial for, those that are possible surgical candidates,” explained Truty.

Results showed that 1 in 5 patients with pancreatic cancer who were evaluated after receiving a laparoscopy showed cancer within the liver and the lining of the abdomen.

Researchers also found factors that could contribute to a more likely cancer spread. These include, the patient's age, the location of the tumor and tumor markers (CA 19-9) found in the blood. The researchers say that the more risk factors that are present, the higher the risk of finding cancer spread, according to the press release.

Risk factors were also prominent within patients with pancreatic cancer.

“When we assessed for factors that increased the likelihood of finding cancer spread during the staging laparoscopy procedure, we found that younger (under 60) age, indeterminate extra pancreatic lesions on preoperative imaging, body/tail tumor location, larger tumor size and elevated serum CA 19-9 were associated with greater yield. Thus, patients with one of more of these factors should have this procedure performed,” explained Truty in a recent interview.

Ultimately, researchers conclude that staging a laparoscopy before undergoing chemotherapy is beneficial to patients with pancreatic cancer. Doing so can guide a patient with pancreatic cancer to the most helpful treatment.

“This study revealed that this simple staging procedure is safe and offers substantial benefits to patients, surgeons and oncologists as it can more accurately stage patients, guide their subsequent therapy, and offer prognostic information to assist in making better informed decisions on their pancreatic cancer care,” Truty said.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.