Yield of Staging Laparoscopy and Lavage Cytology for Radiologically Occult Peritoneal Carcinomatosis of Gastric Cancer

Abstract

Laparoscopy remains a useful staging procedure to evaluate for peritoneal spread when treatment or surgery is considered, even with the current availability of high-quality imaging.

Repeat staging laparoscopy for gastric cancer after preoperative therapy

“…Given that the positive exploration rate was 37% in patients with linitis features on imaging despite negative initial staging laparoscopy, we recommend repeat laparoscopy in these patients. These findings are confirmed by a previous analysis that suggests that linitis features are associated with positive results on initial staging laparoscopy . In addition, our data suggest that repeat staging laparoscopy for patients with poorly differentiated tumors may be warranted since 15% of these patients had a positive exploration.…”

“…As expected, given the selection bias inherent in investigating only those treated with preoperative therapy whose disease did not progress on imaging, the rate of positive exploration in the total cohort was significantly lower than the 36% rate of positive initial staging laparoscopy that we previously reported in pretreatment gastric cancer patients . However, the positive exploration rate was considerably greater than the overall rate of 12% for certain subsets of patients, who would likely benefit from repeated laparoscopic exploration at the time of definitive surgery.…”

“…Although this decision to proceed with resection in the face of equivocal findings must be made on a case‐by‐case basis, previous studies suggest that very few patients with M1 disease will require a surgical intervention . However, both at staging laparoscopy and at repeat laparoscopy, peritoneal metastasis appears to be the most common positive finding, and it typically can be identified at laparoscopic exploration.…”

“…Staging laparoscopy was performed before initiation of therapy. Staging laparoscopy at MD Anderson routinely includes abdominal exploration, including biopsies of any suspicious lesions as well as lavage cytology, as described previously . MD Anderson routinely recommends preoperative chemotherapy or chemoradiation for all advanced gastric cancers (beyond T1aN0 or T1bN0), and the standard practice at the institution is to perform staging laparoscopy before initiation of preoperative therapy …”

“…These practices are supported by data that suggest that radiographically occult M1 disease is found in as many as 40% of patients with these gastric cancers and that non‐therapeutic laparotomy can be avoided in a significant subset of these patients . NCCN guidelines recommend peritoneal lavage cytology at the time of staging laparoscopy, and data on gastric cancer patients undergoing staging laparoscopy suggests that 13% of patients will have positive cytology without gross peritoneal disease . Despite improvements in imaging technology and high variability in utilization, staging laparoscopy remains an important diagnostic tool in the management of gastric cancer in the Western hemisphere …”