Staging laparoscopy for radiographically non-metastatic pancreatic ductal adenocarcinoma: cytology-driven upstaging and the SENDAI-SL risk-enrichment score
Abstract
Background: Cross-sectional imaging may miss occult metastatic disease in pancreatic ductal adenocarcinoma and cannot detect positive peritoneal lavage cytology. This study quantified the yield of staging laparoscopy (SL) with routine lavage cytology and developed the SENDAI-SL score for risk-based prioritization.
Methods: Consecutive patients with radiographically non-metastatic pancreatic ductal adenocarcinoma who underwent SL at one centre from January 2013 to June 2025 were analysed retrospectively. SL positivity was defined as liver metastasis, macroscopic peritoneal metastasis, and/or positive cytology. Multivariable logistic regression identified predictors; internal validation used 2000 bootstrap resamples.
Results: Of 504 patients, 141 (28.0%) had positive SL. Positivity rates were 21.3%, 16.0%, 32.3%, and 41.7% in resectable, borderline resectable with portal vein involvement, borderline resectable with arterial involvement, and unresectable locally advanced disease, respectively. Gross liver or peritoneal metastases were detected in 51 patients (10.1%); cytology was positive in 125 (24.8%) and the sole finding in 90 of 141 positive procedures (63.8%). Among 499 patients with quantifiable serum carbohydrate antigen 19-9, unresectable locally advanced disease, body and/or tail location, tumour size ≥ 37 mm, and serum carbohydrate antigen 19-9 ≥ 180 U/ml were independently associated with SL positivity. The model's area under the receiver operating characteristic curve was 0.732 (optimism-corrected, 0.718). Score-specific positivity ranged from 8.6% to 83.3%. A score ≥ 2 prioritized 149 patients; 74 (49.7%) were positive, capturing 52.9% (74 of 140) of positives in the analysis cohort.
Conclusions: SL upstaged 28.0% of patients, predominantly through cytology-only disease. The SENDAI-SL score may support prioritization when resources are limited but requires external validation and should not justify omitting SL.
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BibTeX
@article{douchi2026staging,
title = {{Staging laparoscopy for radiographically non-metastatic pancreatic ductal adenocarcinoma: cytology-driven upstaging and the SENDAI-SL risk-enrichment score}},
author = {Daisuke Douchi and Shingo Yoshimachi and Naoki Rikiyama and Mika Ando and Yuichiro Umino and Hideaki Sato and Mitsuhiro Shimura and Koetsu Inoue and Masahiro Iseki and Shuichi Aoki and Takayuki Miura and Shimpei Maeda and Masaharu Ishida and Masamichi Mizuma and Atsushi Masamune and Michiaki Unno},
journal = {BJS Open},
year = {2026},
month = nov,
doi = {10.1093/bjsopen/zrag176},
url = {https://doi.org/10.1093/bjsopen/zrag176},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Staging laparoscopy for radiographically non-metastatic pancreatic ductal adenocarcinoma: cytology-driven upstaging and the SENDAI-SL risk-enrichment score
AU - Daisuke Douchi
AU - Shingo Yoshimachi
AU - Naoki Rikiyama
AU - Mika Ando
AU - Yuichiro Umino
AU - Hideaki Sato
AU - Mitsuhiro Shimura
AU - Koetsu Inoue
AU - Masahiro Iseki
AU - Shuichi Aoki
AU - Takayuki Miura
AU - Shimpei Maeda
AU - Masaharu Ishida
AU - Masamichi Mizuma
AU - Atsushi Masamune
AU - Michiaki Unno
PY - 2026
DA - 2026/11/04
JO - BJS Open
DO - 10.1093/bjsopen/zrag176
UR - https://doi.org/10.1093/bjsopen/zrag176
AB - Background: Cross-sectional imaging may miss occult metastatic disease in pancreatic ductal adenocarcinoma and cannot detect positive peritoneal lavage cytology. This study quantified the yield of staging laparoscopy (SL) with routine lavage cytology and developed the SENDAI-SL score for risk-based prioritization. Methods: Consecutive patients with radiographically non-metastatic pancreatic ductal adenocarcinoma who underwent SL at one centre from January 2013 to June 2025 were analysed retrospectively. SL positivity was defined as liver metastasis, macroscopic peritoneal metastasis, and/or positive cytology. Multivariable logistic regression identified predictors; internal validation used 2000 bootstrap resamples. Results: Of 504 patients, 141 (28.0%) had positive SL. Positivity rates were 21.3%, 16.0%, 32.3%, and 41.7% in resectable, borderline resectable with portal vein involvement, borderline resectable with arterial involvement, and unresectable locally advanced disease, respectively. Gross liver or peritoneal metastases were detected in 51 patients (10.1%); cytology was positive in 125 (24.8%) and the sole finding in 90 of 141 positive procedures (63.8%). Among 499 patients with quantifiable serum carbohydrate antigen 19-9, unresectable locally advanced disease, body and/or tail location, tumour size ≥ 37 mm, and serum carbohydrate antigen 19-9 ≥ 180 U/ml were independently associated with SL positivity. The model's area under the receiver operating characteristic curve was 0.732 (optimism-corrected, 0.718). Score-specific positivity ranged from 8.6% to 83.3%. A score ≥ 2 prioritized 149 patients; 74 (49.7%) were positive, capturing 52.9% (74 of 140) of positives in the analysis cohort. Conclusions: SL upstaged 28.0% of patients, predominantly through cytology-only disease. The SENDAI-SL score may support prioritization when resources are limited but requires external validation and should not justify omitting SL.
SN - 2474-9842
ER -