Surgical Laparoscope examining Pancreatic Cancer cell

Pancreatic Cancer Treatment: Is Surgical Restaging Always Necessary?

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Experts debate the role of staging laparoscopy in managing locally advanced pancreatic cancer after chemotherapy and radiation."

The optimal management of locally advanced pancreatic cancer (LAPC) remains a topic of considerable debate among oncologists. A key point of contention is whether surgical restaging, specifically staging laparoscopy, is always necessary after patients undergo concurrent chemoradiation therapy. This approach combines chemotherapy and radiation to shrink the tumor before a potential surgical resection.

A recent exchange in the Journal of Korean Medical Science highlights this very issue. Dr. Karabicak raised concerns about the accuracy of determining whether LAPC is truly localized and resectable using current imaging techniques alone. They advocated for staging laparoscopy as a crucial step to rule out any hidden, minute metastases (cancer spread) that might not be visible on standard scans.

In response, Drs. Woo Hyun Paik and Yong-Tae Kim acknowledged the limitations of current imaging but questioned the absolute necessity of staging laparoscopy in all cases. Their argument centers on the high rates of recurrence even after successful resection and the proven benefits of adjuvant chemotherapy, suggesting that micrometastases may be present even in seemingly resectable cancers.

The Role of Staging Laparoscopy: Essential or Optional?

Surgical Laparoscope examining Pancreatic Cancer cell

Staging laparoscopy involves inserting a thin, lighted tube with a camera into the abdomen to visually inspect the organs for signs of cancer spread. The procedure allows surgeons to identify small metastases that may not be detected by CT scans or MRIs. The argument for routine staging laparoscopy in LAPC stems from the desire to avoid unnecessary surgeries in patients who already have widespread disease.

However, performing staging laparoscopy on every patient also has potential drawbacks:

Invasiveness: Laparoscopy is an invasive procedure that carries risks such as bleeding, infection, and injury to internal organs.
Cost: The procedure adds to the overall cost of cancer treatment.
Delay: It can delay the start of potentially beneficial systemic therapies.
Limited Impact on Survival: Some argue that even if micrometastases are detected and surgery is avoided, the overall survival benefit may be limited, as the cancer is likely to recur despite systemic treatment.

Drs. Paik and Kim point to the fact that more than three-quarters of patients with pancreatic cancer experience tumor recurrence even after radical resection. Adjuvant chemotherapy (chemotherapy given after surgery) has been shown to improve survival rates, suggesting that many patients already have microscopic spread of the disease at the time of diagnosis, regardless of whether it's detectable by laparoscopy. Therefore, they suggest systemic treatment should be prioritized.

Moving Forward: The Need for More Evidence

The debate surrounding staging laparoscopy in LAPC highlights the need for more research to identify which patients benefit most from this procedure. As Drs. Paik and Kim note, the introduction of more effective chemotherapy regimens like FOLFIRINOX may change the landscape of neoadjuvant therapy and influence the role of surgical restaging. Ultimately, the decision of whether or not to perform staging laparoscopy should be made on a case-by-case basis, considering the individual patient's characteristics, the stage of their cancer, and the availability of effective systemic therapies.

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Everything You Need To Know

What is locally advanced pancreatic cancer (LAPC), and why is there so much discussion about the best way to manage it?

Locally advanced pancreatic cancer (LAPC) refers to pancreatic cancer that has spread beyond the pancreas but has not reached distant organs. The optimal way to treat LAPC is under debate by oncologists. One of the biggest issues is if surgical restaging with staging laparoscopy is required after chemoradiation therapy. The controversy exists because it is hard to determine if LAPC is localized and resectable using imaging techniques alone. The use of staging laparoscopy would rule out hidden, minute metastases that may not be visible on standard scans.

Can you explain what staging laparoscopy is and why it's considered an important step in managing LAPC?

Staging laparoscopy is a surgical procedure that involves inserting a thin, lighted tube with a camera into the abdomen to visually inspect the organs for signs of cancer spread. It's important because it can detect small metastases that may not be visible on CT scans or MRIs, potentially preventing unnecessary surgeries in patients with widespread disease. It allows surgeons to identify metastases not seen during imaging, but is invasive, costly, and may delay systemic therapies.

What does concurrent chemoradiation therapy involve, and how does it fit into the treatment of LAPC?

Concurrent chemoradiation therapy involves the combined use of chemotherapy and radiation therapy to treat cancer. This approach is often used to shrink the tumor before a potential surgical resection. It's a method to improve the chances of successful surgery by reducing the size of the tumor and controlling its spread. However, even after chemoradiation, microscopic spread of cancer cells (micrometastases) can still be present. This is why there is an ongoing debate about the necessity of surgical restaging with staging laparoscopy.

What is adjuvant chemotherapy, and why is it significant in the context of pancreatic cancer treatment?

Adjuvant chemotherapy is chemotherapy given after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. It's significant because studies have shown it can improve survival rates in pancreatic cancer patients, suggesting that many patients have microscopic spread of the disease at the time of diagnosis. The effectiveness of adjuvant chemotherapy is a key factor in the debate about whether staging laparoscopy is always necessary, as it implies that micrometastases may be present even in seemingly resectable cancers.

What are metastases, and why is detecting them so important in pancreatic cancer?

Metastases are the spread of cancer cells from the primary tumor to other parts of the body. The presence or absence of metastases is a critical factor in determining the stage of cancer and the appropriate treatment approach. Detecting metastases, especially small ones (micrometastases), is crucial, which is why staging laparoscopy is considered. However, even if metastases are not detected during staging laparoscopy, they may still be present, which is why adjuvant chemotherapy is often recommended.