{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T14:00:55Z","timestamp":1784210455682,"version":"3.55.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with predilection for peritoneal dissemination. Accurate peritoneal staging is imperative for treatment recommendations, as one-third of patients develop peritoneal recurrence after resection. Because >90% of PDAC tumors harbor mutant KRAS<\/jats:italic> (mKRAS<\/jats:italic>), we sought to determine feasibility of mKRAS<\/jats:italic> DNA detection in peritoneal lavage (PL) fluid using droplet-digital polymerase chain reaction (ddPCR) via a prospective trial.<\/jats:p>\n <\/jats:sec>\n \n STUDY DESIGN:<\/jats:title>\n Patients with nonmetastatic PDAC undergoing staging laparoscopy with PL were included. PL fluid was sent for cytologic examination, CA19-9\/CEA levels, and mKRAS<\/jats:italic> ddPCR assay. Clinically positive laparoscopy was defined as gross metastases or positive cytology. PL mKRAS<\/jats:italic> status was compared with gross findings, cytology, and CA19-9\/CEA levels.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n There were 136 patients enrolled; 70 of 136 (51%) patients received neoadjuvant therapy before PL, and 32 of 136 (24%) patients had clinically positive laparoscopy. Cytology was positive in 17 of 136 (13%) patients, and 22 of 136 (16%) patients had gross metastases. Of patients with gross metastases, only 8 of 22 (36%) had positive cytology; 97 of 136 (71%) patients had mKRAS<\/jats:italic> in PL. PL mKRAS<\/jats:italic> was present in 27 of 32 (84%) clinically positive laparoscopies, with higher mean copy number in clinically positive patients (643 vs 10, p = 0.02). Peritoneal mKRAS<\/jats:italic> was positive in an additional 70 clinically negative patients.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n This prospective study establishes the feasibility of PL mKRAS<\/jats:italic> detection. Clinically positive disease was identified in 1 in 4 staging laparoscopies. Although PL mKRAS<\/jats:italic> was highly associated with clinically positive findings, many clinically negative laparoscopies had detectable PL mKRAS,<\/jats:italic> suggesting that standard staging may be inadequate. Longer follow-up will elucidate utility of this promising molecular assay.<\/jats:p>\n <\/jats:sec>","DOI":"10.1016\/j.jamcollsurg.2021.05.009","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T01:54:57Z","timestamp":1621475697000},"page":"73-80e1","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Molecular Peritoneal Staging for Pancreatic Ductal Adenocarcinoma Using Mutant KRAS Droplet-Digital Polymerase Chain Reaction: Results of a Prospective Clinical Trial"],"prefix":"10.1097","volume":"233","author":[{"given":"Jennifer A.","family":"Yonkus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Alva-Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amro M.","family":"Abdelrahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Leiting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber R.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis E.","family":"Grotz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean P.","family":"Cleary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory L.","family":"Smoot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Nagorney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Kendrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin R.","family":"Kipp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Truty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","container-title":["Journal of the American College of Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1072751521003720?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1072751521003720?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1016\/j.jamcollsurg.2021.05.009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T12:35:44Z","timestamp":1724675744000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1016\/j.jamcollsurg.2021.05.009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":0,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jamcollsurg.2021.05.009","relation":{},"ISSN":["1072-7515"],"issn-type":[{"value":"1072-7515","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}