PDF(Pubmed)
Abstract：
BACKGROUND: Initial staging of pancreatic ductal adenocarcinoma (PDAC) is performed with computed tomography (CT). Laparoscopy with peritoneal cytology at staging can uncover occult disease undetected by CT. This case series assessed clinical course following staging laparoscopy with cytology in patients with PDAC.
METHODS: This single-center study examined patients with non-metastatic PDAC diagnosed from 2017 to 2020. Patients underwent CT and subsequent laparoscopy with cytology prior to treatment. Demographics, clinicopathologic status, treatment course, and survival were compared.
RESULTS: Eight patients were identified. All had negative laparoscopies. Five cytologies were negative, two were atypical, and one was positive. Two patients with negative cytology received neoadjuvant chemotherapy and underwent resection, with an average follow-up time of 32.9 months since diagnosis. Of the three remaining patients with negative cytology, none underwent resection. One received delayed chemotherapy, while the others could not due to medical contraindications. The average survival was 3.5 months (n=2). Of two patients with atypical cytology, neither underwent resection. One could not receive chemotherapy due to medical contraindication, while the other was lost to follow-up shortly after diagnosis. The average survival was 1.3 months (n=1). The patient with positive cytology received definitive chemotherapy without resection and survived for 21.6 months.
CONCLUSIONS: The patient with positive cytology may have been spared non-therapeutic surgery. Remaining unresected patients showed poor survival, though the lack of immediate chemotherapy may contribute to this finding. Further research is needed to determine optimal candidates for invasive staging and implications of atypical cytology.
METHODS: This single-center study examined patients with non-metastatic PDAC diagnosed from 2017 to 2020. Patients underwent CT and subsequent laparoscopy with cytology prior to treatment. Demographics, clinicopathologic status, treatment course, and survival were compared.
RESULTS: Eight patients were identified. All had negative laparoscopies. Five cytologies were negative, two were atypical, and one was positive. Two patients with negative cytology received neoadjuvant chemotherapy and underwent resection, with an average follow-up time of 32.9 months since diagnosis. Of the three remaining patients with negative cytology, none underwent resection. One received delayed chemotherapy, while the others could not due to medical contraindications. The average survival was 3.5 months (n=2). Of two patients with atypical cytology, neither underwent resection. One could not receive chemotherapy due to medical contraindication, while the other was lost to follow-up shortly after diagnosis. The average survival was 1.3 months (n=1). The patient with positive cytology received definitive chemotherapy without resection and survived for 21.6 months.
CONCLUSIONS: The patient with positive cytology may have been spared non-therapeutic surgery. Remaining unresected patients showed poor survival, though the lack of immediate chemotherapy may contribute to this finding. Further research is needed to determine optimal candidates for invasive staging and implications of atypical cytology.
摘要：
背景：胰腺导管腺癌（PDAC）的初始分期采用计算机断层扫描（CT）进行。分期进行腹膜细胞学检查的腹腔镜检查可以发现CT未发现的隐匿性疾病。此病例系列评估了PDAC患者在进行细胞学分期腹腔镜检查后的临床过程。
方法：这项单中心研究检查了2017年至2020年诊断为非转移性PDAC的患者。患者在治疗前接受了CT和随后的腹腔镜检查以及细胞学检查。人口统计,临床病理状态，疗程,和生存率进行了比较。
结果：确定了8例患者。所有腹腔镜检查均为阴性。五个细胞学检查是阴性的，两个是非典型的，一个是积极的。2例细胞学阴性的患者接受了新辅助化疗并接受了切除，诊断后平均随访时间为32.9个月。在剩下的三个细胞学阴性的患者中，没有人接受切除。一个人接受了延迟化疗，而其他人由于医学禁忌症而不能。平均生存期为3.5个月(n=2)。在两名非典型细胞学患者中，都没有做过切除手术.一个人因为医学禁忌症不能接受化疗，而另一个在诊断后不久就失去了随访。平均生存期为1.3个月(n=1)。细胞学阳性的患者接受确定性化疗，未切除，存活21.6个月。
结论：细胞学检查阳性的患者可以幸免于非治疗性手术。其余未切除的患者生存不佳，尽管缺乏立即化疗可能有助于这一发现。需要进一步的研究来确定侵入性分期的最佳候选者和非典型细胞学的含义。
方法：这项单中心研究检查了2017年至2020年诊断为非转移性PDAC的患者。患者在治疗前接受了CT和随后的腹腔镜检查以及细胞学检查。人口统计,临床病理状态，疗程,和生存率进行了比较。
结果：确定了8例患者。所有腹腔镜检查均为阴性。五个细胞学检查是阴性的，两个是非典型的，一个是积极的。2例细胞学阴性的患者接受了新辅助化疗并接受了切除，诊断后平均随访时间为32.9个月。在剩下的三个细胞学阴性的患者中，没有人接受切除。一个人接受了延迟化疗，而其他人由于医学禁忌症而不能。平均生存期为3.5个月(n=2)。在两名非典型细胞学患者中，都没有做过切除手术.一个人因为医学禁忌症不能接受化疗，而另一个在诊断后不久就失去了随访。平均生存期为1.3个月(n=1)。细胞学阳性的患者接受确定性化疗，未切除，存活21.6个月。
结论：细胞学检查阳性的患者可以幸免于非治疗性手术。其余未切除的患者生存不佳，尽管缺乏立即化疗可能有助于这一发现。需要进一步的研究来确定侵入性分期的最佳候选者和非典型细胞学的含义。
