Staging laparoscopy combined with ultrasonography and near-infrared fluorescence imaging to detect occult pancreatic metastases

Even after extensive preoperative assessment, up to 38% of patients undergoing laparotomy with curative intent turn out to have metastases or unresectable disease, preventing curative surgery. Moreover, a substantial number of patients present shortly after surgery with liver metastases that must have been present during surgery, but have not been identified. SL combined with LUS and NIR fluorescence imaging may identify metastases and unresectable disease, sparing patients with incurable disease the morbidity, inconvenience and expense of a futile operation. Staging laparoscopy in pancreatic cancer patients is being advocated in literature, but has not yet been implemented in clinical guidelines.This is a phase II single center, single-arm trial to assess the added value of staging laparoscopy (SL), laparoscopic ultrasonography (LUS) and near-infrared (NIR) fluorescence imaging in patients with pancreatic cancer undergoing resection with curative intent.

The yield of staging laparoscopy will be increased by adding laparoscopic ultrasound and laparoscopic near-infrared fluorescence imaging.

3 months follow-up

In addition to standard-of-care, patients will receive an intravenous injection of 10 mg ICG 1-3 days prior to surgery. During surgery, patients undergo a SL, whereupon inspection, LUS and NIR fluorescence imaging will be performed. A biopsy will be taken from any suspect lesions. Decision to continue the resection is up to the surgeon. Follow-up will last at least 6 months.