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David R. Urbach, MD; Lee L. Swanstrom, MD; Paul D. Hansen, MD

Arch Surg. 2002;137:191-199.

Hypothesis  Exposure to laparoscopy influences survival in patients with unresected pancreatic cancer who have a diagnostic or staging surgical procedure.

Methods  We used the Surveillance, Epidemiology, and End Results Medicare-linked database to identify a cohort of persons 65 years and older, who were newly diagnosed with primary pancreatic cancer between 1991 and 1996 and who had a diagnostic laparoscopy or laparotomy during the course of their disease. Patients with a prior malignancy and those who had a pancreatic resection were excluded. We used proportional-hazards regression to adjust risk estimates for demographic factors, medical comorbidities, tumor characteristics, and the use of other treatment modalities.

Results  We identified 112 individuals with pancreatic cancer who had a laparoscopic procedure and 791 who had only conventional surgery. More patients who had laparoscopic surgery had distant metastases at diagnosis (67.9% vs 41.2%; P = .001). Median duration of survival in the laparoscopic surgery group was 4.8 months (95% confidence interval [CI], 4.1-6.8) compared with 5.3 months in the group that had only open surgery (95% CI, 4.9-5.6; P = .83). Compared with patients who only had a laparotomy, patients who had laparoscopic surgery did not have an increased rate of death when adjusted for the effects of age, sex, tumor size, grade, the presence of nodal and distant metastases at diagnosis, and the use of radiation, chemotherapy, therapeutic endoscopic retrograde cholangiopancreatography, and biliary and gastric bypass (adjusted hazard ratio, 0.93; 95% CI, 0.62-1.40).

Conclusion  Exposure to laparoscopic surgery did not adversely affect survival in a cohort of elderly patients with pancreatic cancer who had a diagnostic procedure but no pancreatic resection.

From the Divisions of General Surgery and Clinical Decision Making and Health Care, University Health Network, Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (Dr Urbach); and the Department of Minimally Invasive Surgery and Surgical Research, Legacy Health Systems, Portland, Ore (Drs Swanstrom and Hansen).

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