Which gastric cancer patients could benefit from staging laparoscopy? A GIRCG multicenter cohort study

Solaini, Leonardo; Bencivenga, Maria; D’Ignazio, Alessia; Milone, Marco; Marino, Elisabetta; Ascari, Filippo; Rosa, Fausto; Sacco, Michele; Romario, Uberto Fumagalli; Graziosi, Luigina; Palma, Giovanni Domenico De; Marrelli, Daniele; Morgagni, Paolo; Ercolani, Giorgio

doi:10.1016/j.ejso.2022.01.020

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…Second, during the fifteen year-long study interval, several major changes in the management of stage IV gastric cancer have been introduced and this resulted in the heterogeneity of treatment seen in our analysis. As such, staging laparoscopy was not routinely performed as it was after 2013 ( 20 , 21 ) and this may have had an impact on the type of treatment received. Finally, it must be observed that the upfront surgery group may have included a higher rate of symptomatic cases and/or elderly patients who were not fit for preoperative treatment.…”

Section: Discussionmentioning

confidence: 99%

Conversion Surgery in Gastric Cancer Carcinomatosis

et al. 2022

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BackgroundAfter the REGATTA trial, patients with stage IV gastric cancer could only benefit from chemotherapy (CHT). However, some of these patients may respond extraordinarily to palliative chemotherapy, converting their disease to a radically operable stage. We present a single centre experience in treating peritoneal carcinomatosis from gastric cancer.MethodsAll patients with stage IV gastric cancer with peritoneal metastases as a single metastatic site operated at a single centre between 2005 and 2020 were included. Cases were grouped according to the treatment received.ResultsA total of 118 patients were considered, 46 were submitted to palliative gastrectomy (11 were considered M1 because of an unsuspected positive peritoneal cytology), and 20 were submitted to Hyperthermic Intraperitoneal Chemotherapy (HIPEC) because of a <6 Peritoneal Cancer Index (PCI). The median overall survival (OS) after surgery plus HIPEC was 46.7 (95% CI 15.8–64.0). Surgery (without HIPEC) after CHT presented a median OS 14.4 (8.2–26.8) and after upfront surgery 14.7 (10.9–21.1). Patients treated with upfront surgery and considered M1 only because of a positive cytology, had a median OS of 29.2 (25.2–29.2). The OS of patients treated with surgery plus HIPEC were 60.4 months (9.2–60.4) in completely regressed cancer after chemotherapy and 31.2 (15.8–64.0) in those partially regressed (p = 0.742).ConclusionsConversion surgery for peritoneal carcinomatosis from gastric cancer was associated with long survival and it should always be taken into consideration in this group of patients.

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Section: Discussionmentioning

confidence: 99%

Conversion Surgery in Gastric Cancer Carcinomatosis

et al. 2022

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“…On CT, main manifestations are localized or diffuse gastric wall thickening, the gastric wall thickening is usually uneven, and even ulcers can be seen, and the localized appearance of this cancer is rigid [ 20 , 21 ]. CT can not only show changes of the gastric wall itself but it can also show the tumor's invasion to the surrounding, local or distant metastasis, such as the perigastric lymph node enlargement, ascites, thickening of the omentum and mesentery, and implanted nodules, showing a high application value in the diagnosis and the treatment of gastric cancer [ 22 , 23 ]. Gastric cancer is divided into four stages according to CT manifestations.…”

Section: Discussionmentioning

confidence: 99%

Efficacy Evaluation of 64‐Slice Spiral Computed Tomography Images in Laparoscopic‐Assisted Distal Gastrectomy for Gastric Cancer under the Reconstruction Algorithm

Zhou

et al. 2022

Contrast Media & Molecular Imaging

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This study was aimed to analyze the application value of the filtered back-projection (FBP) reconstruction algorithm of computed tomography (CT) images in laparoscopic-assisted distal gastrectomy. In this study, 56 patients with gastric cancer were selected as research subjects and randomly divided into the control group (CT-guided laparoscopic radical gastrectomy) and the observation group (CT-guided laparoscopic radical gastrectomy with the FBP reconstruction algorithm), with 28 patients in each group. Fourier transform and iterative reconstruction were introduced for comparison, and finally, the postoperative curative effect and adverse events were compared between the two groups. The results showed that the CT image quality score processed by the FBP reconstruction algorithm (4.31 ± 0.31) was significantly higher than that of the iterative reconstruction method (3.5 ± 0.29) and the Fourier transform method (3.97 ± 0.38) ( P < 0.05 ). The incidences of postoperative wound infection and gastric motility disorder (5.88% and 8.16%, respectively) in the observation group were significantly lower than those in the control group (8.21% and 10.82%, respectively) ( P < 0.05 ). The levels of serum interleukin-6 (IL-6) (280.35 ± 15.08 ng/L) and tumor necrosis factor-α (TNF-α) (144.32 ± 10.32 ng/L) in the observation group after the treatment were significantly lower than those in the control group, which were 399.71 ± 14.19 ng/L and 165.33 ± 10.08 ng/L, respectively ( P < 0.05 ). In conclusion, the FBP reconstruction algorithm was better than other algorithms in the processing of gastric cancer CT images. The FBP reconstruction algorithm showed a good reconstruction effect on CT images of gastric cancer; CT images based on this algorithm helped to formulate targeted surgical treatment plans for gastric cancer, showing a high clinical application value.

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“…According to the 6th edition of the Japanese Gastric Cancer Treatment Guidelines [ 16 ], SL is weakly recommended to establish the therapeutic strategy for patients with advanced GC with a high risk of peritoneal carcinomatosis. Several studies investigating clinical, radiological, and pathological features associated with peritoneal carcinomatosis or cytology identified linitis plastica, Bormann type 3–4, poor histological poor differentiation, and suspected lymphadenopathy at CT scan as risk factors at multivariate analysis [ 24 , 25 , 26 , 27 , 28 , 29 ].…”

Section: Indications For Staging Laparoscopy (Sl)mentioning

confidence: 99%

The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives

Schena

Laterza

Sio

et al. 2023

Cancers

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A significant proportion of patients diagnosed with gastric cancer is discovered with peritoneal metastases at laparotomy. Despite the continuous improvement in the performance of radiological imaging, the preoperative recognition of such an advanced disease is still challenging during the diagnostic work-up, since the sensitivity of CT scans to peritoneal carcinomatosis is not always adequate. Staging laparoscopy offers the chance to significantly increase the rate of promptly diagnosed peritoneal metastases, thus reducing the number of unnecessary laparotomies and modifying the initial treatment strategy of gastric cancer. The aim of this review was to provide a comprehensive summary of the current literature regarding the role of staging laparoscopy in the management of gastric cancer. Indications, techniques, accuracy, advantages, and limitations of staging laparoscopy and peritoneal cytology were discussed. Furthermore, a focus on current evidence regarding the application of artificial intelligence and image-guided surgery in staging laparoscopy was included in order to provide a picture of the future perspectives of this technique and its integration with modern tools in the preoperative management of gastric cancer.

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Which gastric cancer patients could benefit from staging laparoscopy? A GIRCG multicenter cohort study

Cited by 5 publications

References 31 publications

Conversion Surgery in Gastric Cancer Carcinomatosis

Conversion Surgery in Gastric Cancer Carcinomatosis

Efficacy Evaluation of 64‐Slice Spiral Computed Tomography Images in Laparoscopic‐Assisted Distal Gastrectomy for Gastric Cancer under the Reconstruction Algorithm

The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives

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