Pancreatic cancer: occult spread in 1 in 4

In this prospective multicenter cohort, staging laparoscopy found occult metastases in 25% of imaging-M0 patients—including 20.6% with resectable disease—potentially sparing some patients a nonbeneficial resection.

• The rate was 33.8% in borderline-resectable or locally advanced disease.
• In patients not given neoadjuvant therapy, borderline/locally advanced status and body/tail location were independently associated with metastases.

Resectable head tumors with normal markers may be a low-risk group for selective omission, but this finding is not validated; no significant predictors emerged in the smaller borderline/locally advanced subgroup.