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. 2020 Feb 17;18(1):39.
doi: 10.1186/s12957-020-01813-y.

Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

Casey J Allen  1 , Alisa N Blumenthaler  1 , Prajnan Das  2 , Bruce D Minsky  2 , Mariela Blum  3 , Sinchita Roy-Chowdhuri  4 , Jaffer A Ajani  3 , Naruhiko Ikoma  1 , Paul F Mansfield  1 , Brian D Badgwell  5
Affiliations

Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

Casey J Allen et al. World J Surg Oncol. .

Abstract

Background: Staging laparoscopy and peritoneal cytology can detect occult metastatic disease prior to treatment of gastric cancer. The yield of peritoneal staging in patients with early stage disease is lacking. We assess the yield of peritoneal staging in early stage gastric cancer and its impact on survival.

Methods: Data were obtained from a prospective database of patients who underwent staging laparoscopy and peritoneal cytology for gastric cancer at our institution between July 1995 and July 2018. Clinical stage was determined by endoscopic ultrasound, and early stage was defined as cT1-2 and cN0. Rates of positive cytology and carcinomatosis at time of laparoscopy were obtained. Univariate analyses were used to compare groups, and Kaplan-Meier survival analyses were used to assess survival outcomes.

Results: Eight hundred sixty-seven patients underwent staging laparoscopy and peritoneal cytology; 56 were defined as early stage. Age was 61 ± 12 years, 66.4% were male, and 62.3% were white. Of the patients with early stage disease, 17.9% had either gross carcinomatosis (10.7%) and/or positive peritoneal cytology (10.9%). All cases of peritoneal disease were in patients with cT2 disease. There were no differences in age, gender, or race based on peritoneal disease (all p > 0.05). The presence of carcinomatosis or positive cytology significantly affected overall survival (p < 0.001), regardless of clinical T or N stage.

Conclusions: Peritoneal staging identifies metastatic disease in a significant number of patients with early stage disease. Given its poor prognosis and alternate therapy options, independent staging laparoscopy and peritoneal cytology should be considered in patients with early stage gastric adenocarcinoma.

Keywords: Cancer; Carcinomatosis; Peritoneal staging; Stomach; Survival.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Gross carcinomatosis on staging laparoscopy. a Patient with mid-gastric adenocarcinoma with serosal invasion and peritoneal carcinomatosis. b Patient with distal gastric adenocarcinoma and gross peritoneal carcinomatosis identified on staging laparoscopy
Fig. 2
Fig. 2
Kaplan-Meier survival analyses (n = 867). a Effect of SL/PC on survival stratified by N status. b Effect of SL/PC on survival stratified by T stage. c Effect of SL/PC on survival stratified by T and N status
See this image and copyright information in PMC

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