Role of staging laparoscopy for gastric cancer patients

Abstract

Staging laparoscopy (SL) is frequently carried out in patients with advanced gastric cancer. However, some clinical questions are being debated and consensus must be obtained. With this aim, a literature search of PubMed/MEDLINE was carried out using the keywords “gastric cancer,” “SL,” and “diagnostic laparoscopy”. Articles published online up to February 2019 were analyzed, focusing on the following questions. (i) What is an adequate indication for SL? (ii) How do you carry out SL? (iii) Does SL provide accurate information about peritoneal dissemination? (iv) Is the yield of SL different by tumor location? (v) Is SL a safe procedure? (vi) Is “repeat SL” needed? (vii) Does SL provide oncological benefit? Results provided the following responses: (i) In Western countries, clinically resectable advanced tumor is an indication for SL. Terms to be introduced for adequate indication include “location,” “type 4 (linitis feature),” “large tumor,” “equivocal computed tomography (CT] findings,” and “lymph node swelling”. (ii) Exploration of the entire peritoneal cavity is preferable. (iii) Detection rate of peritoneal disease is 43%‐52% in Japanese institutions and 7.8%‐40% in other countries. False‐negative findings during SL were 0%‐17%, and 10%‐13% when limited to cytology. (iv) Yield of SL was higher in gastric cancer compared with esophagogastric junctional tumor. (v) SL‐related complications were estimated to occur in 0.4%. (vi) Repeat SL is important after treatment. (vii) If the efficacy of neoadjuvant chemotherapy for patients with P0CY1 is established, SL can provide oncological benefit. SL can be carried out safely and effectively. Considering the prevalence of neoadjuvant treatment, the role of SL will become more important.

Prognostic significance of surgery after chemotherapy in patients with type 4 gastric cancer

“…In this study, majority of patients underwent staging laparoscopy. The false-negative rate of staging laparoscopy for detecting peritoneal dissemination is reported to be 0-17.2% [24]. Accordingly, these ndings suggest that staging laparoscopy has an important role for an accurate assessment of peritoneal dissemination in patients with type 4 gastric cancer.…”

Prognostic Significance of Surgery After Chemotherapy in Patients with Type 4 Gastric Cancer: A Retrospective Study

“…In this study, majority of patients underwent staging laparoscopy. The false-negative rate of staging laparoscopy for detecting peritoneal dissemination is reported to be 0-17.2% [16]. Accordingly, these ndings suggest that staging laparoscopy has an important role for an accurate assessment of peritoneal dissemination in patients with type 4 gastric cancer.…”

Gastric Cancer with Radiographically Occult Metastatic Disease: Biology, Challenges, and Diagnostic Approaches

“…Accurate staging prior to surgery is critical in the management of localized gastric cancer for appropriate treatment planning and accurate prognostication. Unlike Asian countries with well-developed screening endoscopy programs [10,11], the majority of Western patients present with advanced diseases. Even in patients thought to have localized diseases, the suboptimal survival of Western cohorts compared to those of the East is likely related to differences in surgical quality control and inadequate staging.…”

“…Reported positive laparoscopy rates are highly variable (13-63%), owing to variable study inclusion criteria [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The majority of the literature regarding laparoscopy has been published by Asian centers [20,21,24,29,[31][32][33]36,37] where the indication for staging laparoscopy is often the presence of locally advanced diseases, defined as nodal involvement or T3/T4 disease without evidence of metastasis [10,11,20,21,[29][30][31][32]36,37]. The yield of laparoscopy is related to the disease stage.…”

“…As expected, when patients with earlier stage diseases undergo routine laparoscopy, the yield decreases but continues to have a considerable clinical impact (17-41%) [12,23,28,34,35,[38][39][40]. The yield of staging laparoscopy appears to be higher in distil gastric cancers compared to Gastroesophageal (GE) junction tumors and diffuse gastric cancers compared to intestinal-type cancers [10,41] In addition to white light laparoscopy, peritoneal lavage should be obtained at the time of diagnostic laparoscopy for cytological analysis. Even in the absence of overt peritoneal spread, the presence of malignant cells in the peritoneal cytology is a poor prognostic sign [42,43] and is treated a clinical metastatic disease.…”