Staging laparoscopy significantly lowers the rate of unnecessary laparotomies in pancreatic cancer patients post-neoadjuvant treatment.

• Non-therapeutic laparotomy rates dropped to 4.5% with staging laparoscopy, compared to 17.1% without (p=0.002; NNT 8).
• Occult metastases were found in 12.1% of patients, mainly leading to aborted surgeries.

Tailoring staging laparoscopy for patients with tumor size ≥3 cm or CA19-9 >500 U/ml could enhance surgical outcomes.

• In patients with risk factors, the incidence of occult metastatic disease increased to 14.8% and 28.9%, indicating a need for careful patient selection.