PMID- 30478680
OWN - NLM
STAT- MEDLINE
DCOM- 20190626
LR  - 20200225
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 43
IP  - 3
DP  - 2019 Mar
TI  - Opportunity Lost? Diagnostic Laparoscopy in Patients with Pancreatic Cancer in 
      the National Surgical Quality Improvement Program Database.
PG  - 937-943
LID - 10.1007/s00268-018-4855-8 [doi]
AB  - BACKGROUND: Routine preoperative staging in pancreas cancer is controversial. We 
      sought to evaluate the rates of diagnostic laparoscopy (DLAP) for pancreatic 
      cancer. METHODS: We queried the National Surgical Quality Improvement Program for 
      patients with pancreas cancer (2005-2013) and compared groups who underwent DLAP, 
      exploratory laparotomy (XLAP), pancreas resection (RSXN) or therapeutic bypass 
      (THBP). We compared demographics, comorbidities, postoperative complications, 
      30-day mortality (Chi-square P < 0.05) and trends over time (R(2) 0-1). RESULTS: 
      We identified 17,138 patients (RSXN 81.8%, XLAP 16.5%, THBP 8.2%, and DLAP 
      12.9%), with some having multiple CPT codes. Only 10.3% (n = 1432) of RSXN 
      patients underwent DLAP prior to resection. XLAP occurred in 49.5% of non-RSXN 
      patients, of whom 67.1% had no other operation. The percentage of patients 
      undergoing RSXN increased 20.3% over time (R(2) 0.81), while DLAP decreased 52.6% 
      (R(2) 0.92). XLAP patients without other operations decreased from 4.2 to 2.4%, 
      although not linearly (R(2) 0.31). Only 10.3% of XLAP had a diagnostic 
      laparoscopy as well, leaving nearly 90% of these patients with an exploratory 
      laparotomy without RSXN or THBP. DISCUSSION: Diagnostic laparoscopy for pancreas 
      malignancy is becoming less common but could benefit a subset of patients who 
      undergo open exploration without resection or therapeutic bypass.
FAU - Paracha, Munizay
AU  - Paracha M
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
FAU - Van Orden, Kathryn
AU  - Van Orden K
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
FAU - Patts, Gregory
AU  - Patts G
AD  - Boston University School of Public Health, Boston, MA, USA.
FAU - Tseng, Jennifer
AU  - Tseng J
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
FAU - McAneny, David
AU  - McAneny D
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
FAU - Sachs, Teviah
AU  - Sachs T
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA, USA. 
      teviah.sachs@bmc.org.
AD  - Department of Surgical Oncology, Boston Medical Center, 820 Harrison Avenue, FGH 
      Building - Suite 5007, Boston, MA, 02118, USA. teviah.sachs@bmc.org.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Aged
MH  - Databases, Factual
MH  - Female
MH  - Humans
MH  - Laparoscopy/statistics & numerical data/*trends
MH  - Laparotomy/trends
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Staging/methods/trends
MH  - Outcome Assessment, Health Care
MH  - Pancreatectomy/*trends
MH  - Pancreatic Neoplasms/*diagnosis/*surgery
MH  - Postoperative Complications/surgery
MH  - *Quality Improvement
EDAT- 2018/11/28 06:00
MHDA- 2019/06/27 06:00
CRDT- 2018/11/28 06:00
PHST- 2018/11/28 06:00 [pubmed]
PHST- 2019/06/27 06:00 [medline]
PHST- 2018/11/28 06:00 [entrez]
AID - 10.1007/s00268-018-4855-8 [pii]
AID - 10.1007/s00268-018-4855-8 [doi]
PST - ppublish
SO  - World J Surg. 2019 Mar;43(3):937-943. doi: 10.1007/s00268-018-4855-8.