The Current Role of Staging Laparoscopy in Oesophagogastric Cancer

Abstract

INTRODUCTION Oesophagogastric cancers are known to spread rapidly to locoregional lymph nodes and by transcoelomic spread to the peritoneal cavity. Staging laparoscopy combined with peritoneal cytology can detect advanced disease that may not be apparent on other staging investigations. The aim of this study was to determine the current value of staging laparoscopy and peritoneal cytology in light of the ubiquitous use of computed tomography in all oesophagogastric cancers and the addition of positron emission tomography in oesophageal cancer. METHODS All patients undergoing staging laparoscopy for distal oesophageal or gastric cancer between March 2007 and August 2013 were identified from a prospectively maintained database. Demographic details, preoperative staging, staging laparoscopy findings, cytology and histopathology results were analysed. RESULTS A total of 317 patients were identified: 159 (50.1%) had gastric adenocarcinoma, 136 (43.0%) oesophageal adenocarcinoma and 22 (6.9%) oesophageal squamous carcinoma. Staging laparoscopy revealed macroscopic metastases in 36 patients (22.6%) with gastric adenocarcinoma and 16 patients (11.8%) with oesophageal adenocarcinoma. Positive peritoneal cytology in the absence of macroscopic peritoneal metastases was identified in a further five patients with gastric adenocarcinoma and six patients with oesophageal adenocarcinoma. There was no significant difference in survival between patients with macroscopic peritoneal disease and those with positive peritoneal cytology (p=0.219). CONCLUSIONS Staging laparoscopy and peritoneal cytology should be performed routinely in the staging of distal oesophageal and gastric cancers where other investigations indicate resectability. Currently, in our opinion, patients with positive peritoneal cytology should not be treated with curative intent.

Role of staging laparoscopy for gastric cancer patients

“…Irino et al, Hosogi et al, Miki et al, Ishigami et al, Yamagata et al and Nakagawa et al reported the detection rate of P1 and/or CY1 as 47%, 45%, 53.4%, 42.7%, 46% and 51.6%, respectively. Results of these studies from Japanese institutions were almost similar (range: 42.7% to 53.4%), and higher than those from other countries (range: 7.8% to 40%) . The reason for this discrepancy was the difference in the indication for SL.…”

“…Staging laparoscopy is considered a safe procedure carried out within one hour under general anesthesia. Some reported intestinal injury during SL . In many reports, there were no SL‐related complications (Table ), but the estimated SL‐related complication rate was 0.4% based on total accumulated data.…”

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

“…Auch bei makroskopisch unauffälliger Staging-Laparoskopie ohne Nachweis von peritonealen Metastasen ist beim lokal fortgeschrittenen Magenkarzinom oder Karzinom des ösophagogastralen Übergangs (AEG) mit einer positiven Zytologie zu rechnen [366]. Deshalb sollte die Peritoneallavage mit Zytologie ein integraler Bestandteil der diagnostischen Laparoskopie vor Therapieentscheid sein und in standardisierter Technik vorgenommen werden [367].…”

New insights in diagnostic laparoscopy

“…Staging laparoscopy has been integrated into the therapeutic decision making in abdominal cancers for many years. Thereby, the yield of diagnostic laparoscopy is higher in patients suffering from gastric tumors [4][5][6] than in cases of esophago-gastric junction cancer [7,8] (Table 1). One reason seems to be the easy accessibility to the main part of the stomach and a disparate anatomical concept of lymphatic drain.…”