A cost analysis of performing staging diagnostic laparoscopy prior to neoadjuvant chemoradiation in borderline resectable pancreatic cancer

Introduction: Treatment of pancreatic cancer presents a significant burden on patients and the healthcare system. This retrospective study examines the cost and outcomes of performing staging diagnostic laparoscopy (SDL) prior to neoadjuvant therapy (NAT) for borderline resectable pancreatic cancer (BRPC). Methods: Patients treated for BRPC between January 2010 and October 2013 were included. Outcomes for patients who underwent SDL were compared to those who did not. Direct costs of pancreatic cancer treatment were tabulated for each patient. Cost ratios (CR) were calculated, defined as the mean cost for the SDL group divided by the mean cost for the no-SDL group, with ratios calculated for overall cost and subcategories. Results: There were 100 patients with BRPC who were eligible for NAT. Nineteen of 75 SDLs performed (25%) revealed occult metastatic disease. For the SDL group compared to no-SDL group, there was a higher cost for port ± SDL (CR 7.00, 95% CI 4.22–13.78), but there was no difference in overall cost (CR 0.95, 95% CI 0.62–1.37), oncologic treatment (CR 0.66, 95% CI 0.32–1.23) or remaining surgical treatment (CR 1.14, 95% CI 0.77–1.71). Patients with a positive SDL incurred a lower overall cost compared to negative SDL (CR 0.23, 95% CI 0.16–0.32). Median survival was estimated to be 11.5, 6.8, and 16.6 months for the no-SDL, positive SDL, and negative SDL groups, respectively (log rank p < 0.001). Conclusion: SDL identified 25% of patients with BRPC who have occult metastatic disease at diagnosis, which resulted in decreased cost for these patients.