Role of preoperative abdominal MRI in preventing futile laparotomy or diagnostic staging laparoscopy in the setting of pancreatic adenocarcinoma

Among patients with pancreatic cancer deemed resectable on computed tomography (CT), approximately 41% have more advanced disease that is not detected by CT. Diagnostic staging laparoscopy is used preoperatively either routinely or selectively in patients with high-risk features and may reduce unnecessary laparotomies by more than 20%. However, it remains an invasive procedure that requires general anesthesia and, when possible, should be avoided if metastatic disease is already evident on preoperative imaging. CT remains the standard imaging modality for staging pancreatic cancer and determining its resectability, but recent studies have demonstrated the added benefit of other radiological modalities in reducing unnecessary surgeries. Magnetic resonance imaging (MRI) is recommended for patients with high risk features to detect extra-pancreatic metastases or for those with indeterminate liver lesions on CT. Accordingly, at a population-level, we evaluated whether patients diagnosed with pancreatic adenocarcinoma and receiving preoperative abdominal MRI, in lieu of or combined with CT, had a lower likelihood of laparotomy and/or laparoscopy.