The expanding utility of diagnostic laparoscopy in pancreatic ductal adenocarcinoma.

658 Background: Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by radiographically occult metastatic disease. Diagnostic laparoscopy (DL) prevents non-therapeutic laparotomies by detecting occult metastases and guiding treatment. The aim of this study was to assess the clinical utility of DL in patients with PDAC stratified by perceived resectability (resectable, borderline resectable (BR), and locally advanced (LA)) and to identify risk factors for a positive DL. Methods: We retrospectively reviewed the electronic medical records of all PDAC patients without confirmed metastases who underwent DL at a tertiary medical center from January 2018 to June 2024. Data on demographics, imaging, tumor markers, DL findings, and outcomes were collected. Results: 435 patients met the study criteria. Before DL, 115 (26.4%) had perceived resectable, 165 (37.9%) had BR, and 155 (35.6%) had LA disease. DL revealed metastases in 20.0%, 23.0%, and 54.8%, and resection rates were 68.7%, 30.1%, and 5.2% in resectable, BR, and LA cases, respectively. In multivariable analysis, patients with resectable disease had smaller tumors, lower CA 19-9 levels, and were older (all p