Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

Nakagawa, Satoru; Nashimoto, Atsushi; Yabusaki, Hiroshi

doi:10.1007/s10120-006-0406-3

Cited by 91 publications

(65 citation statements)

References 16 publications

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“…Thus, staging laparoscopy has to be considered mandatory in the evaluation of GLP. It may have a role in confirming the diagnosis in doubtful cases, by demonstrating undiagnosed peritoneal seeding and by evaluating tumor resectability [13,14]. Explorative laparotomy should be avoided completely, if we consider the minimal life expectancy of these patients (median survival time 2.8 months).…”

Section: Discussionmentioning

confidence: 99%

Gastric linitis plastica: which role for surgical resection?

et al. 2011

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Background The role of surgery for gastric linitis plastica (GLP) is questioned. This study aimed to analyze our experience in the surgical treatment of GLP with specific reference to the resectability rate, prognosis, and mode of recurrence. Methods Results of surgery were analyzed in 102 patients with GLP. Results Of the 102 patients, 92 underwent surgical exploration, with resection performed in 60 cases. R2 resection was carried out in 20 patients and R1 in 12 patients, while the resection was considered potentially curative (R0) in 28 (27.5%). Overall, the median (95% confidence interval [CI]) survival time was 5.7 (3.7-7.5) months, with none of the patients alive at the end date of the study. For R0 patients the median (95% CI) survival time was 15.8 (11-20.7) months. The great majority of recurrences were intra-abdominal (peritoneal and/or locoregional), with a systemic component of the relapse that was rarely observed (5 cases). Conclusions After primary surgery, GLP showed a poor prognosis without regard to the extent or type of resection. The failure of surgical treatment related mainly to the peritoneal spread of the disease. Specifically designed multimodality treatment protocols should be tested in this setting.

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Section: Discussionmentioning

confidence: 99%

Gastric linitis plastica: which role for surgical resection?

et al. 2011

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“…Laparoscopy was reported to be an important diagnostic tool for the staging of advanced gastric cancer [20,21], and we too have performed it for patients with clinical T3 gastric cancer, by preoperative multidetector row CT since September 2002. Although staging laparoscopy facilitates a more accurate preoperative diagnosis of peritoneal dissemination, there is no standard treatment for peritoneal dissemination.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

et al. 2010

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dissemination still have a poor prognosis [1]; most of these patients die within 6 months of diagnosis, while the 5-year survival rate is nil [2,3].The recent introduction of an oral drug, S-1, has increased the overall response rates (ORRs) to 44% and 49% and median survival time (MST) to 8 months in phase II studies [4,5].Several reports have demonstrated that S-1 was effective for undifferentiated histological types, such as poorly differentiated adenocarcinoma and signet-ring cell carcinoma, which are relevant to peritoneal dissemination [6]. S-1 has been reported to be effective in prolonging the survival of gastric cancer patients with peritoneal dissemination [4][5][6][7].Moreover, S-1 in combination with other anticancer drugs such as cisplatin (CDDP), taxanes, and irinotecan (CPT-11) increased ORRs and prolonged MST [8][9][10][11].Paclitaxel is a cytotoxic antineoplastic agent that causes excessive polymerization of tubulin and microtubule dysfunction, resulting in tumor cell death [12]. Kobayashi et al. [13] have demonstrated that paclitaxel is a promising drug for the treatment of malignant ascites in patients with gastric cancer: the concentration of paclitaxel in ascites was maintained within the optimal level for the treatment of cancer cells for up to 72 h after intravenous administration.Recent phase II studies of systemic chemotherapy with S-1 plus taxanes have demonstrated strong anticancer effects and a good MST in the treatment of advanced gastric cancer [9,10,14]. However, the effi cacy of systemic chemotherapy for peritoneal dissemination from gastric cancer has been unclear, because peritoneal metastases have not been defi ned as measurable lesions in conventional phase II studies. Therefore, few reports describing the effi cacy of chemotherapy for these lesions are available.In this pilot study, we planned therapeutic strategies to observe the effect of chemotherapy on peritoneal metastasis by second-look laparoscopy for patients Abstract Background. This pilot study was carried out to evaluate the effi cacy of chemotherapy for patients with peritoneal dissemination from gastric cancer or positive lavage cytology diagnosed by staging laparoscopy. Methods. Sixteen patients were enrolled. Paclitaxel was administered at 120 mg/m 2 on day 1 and S-1 was administered orally at 80 mg/m 2 for 14 consecutive days, followed by a 1-week rest, as one course. After fi ve courses of this therapy, the primary gastric tumors were evaluated and second-look laparoscopy was performed for patients showing partial response or stable disease with clinical benefi t. Results. Partial response or stable disease with clinical benefi t was confi rmed in seven and fi ve patients, respectively, and these patients underwent second-look laparoscopy. No viable cancer cells were detected on cytopathological investigation during second-look laparoscopy in 9 patients who underwent surgical treatment. The intent-to-treat response rate for gastric tumor was 44% and the rate of disappearance of peritoneal metastasis was 38% ...

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“…Current imaging studies rarely detect peritoneal deposits, although the detection of even minute amounts of cancer, such as those represented by positive cytology of peritoneal washes, usually renders the cancer incurable [9]. This knowledge prompted several investigators to perform staging laparoscopy prior to radical surgery [10]. However, it is not currently considered as a part of routine preoperative workup in Japan, where gastric cancer is one of the commonest types of cancer and is often treated at community hospitals in the hands of general surgeons.…”

Section: Introductionmentioning

confidence: 99%