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. 2024 Apr;106(4):369-376.
doi: 10.1308/rcsann.2022.0140. Epub 2023 Aug 29.

A preoperative predictive tool to assess the need for staging laparoscopy in oesophagogastric cancer patients

J M Halle-Smith  1   2 , T Bage  1 , S K Kamarajah  1   2 , M Siddaiah-Subramanya  1 , R Pande  1 , J L Whiting  1 , E A Griffiths  1   2
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A preoperative predictive tool to assess the need for staging laparoscopy in oesophagogastric cancer patients

J M Halle-Smith et al. Ann R Coll Surg Engl. 2024 Apr.

Abstract

Introduction: Staging laparoscopy (SL) has become commonplace in the preoperative staging pathway for oesophagogastric (OG) cancer. SL is often performed before curative treatment to examine for macroscopic peritoneal metastases (PM) or positive peritoneal cytology (PPC). The aim of this study was to develop an objective risk scoring system to predict both PM and PPC at SL.

Methods: A prospectively collected and maintained database of all OG cancer patients treated between 2006 and 2020 was reviewed. Univariate and multivariate analyses were performed to identify risk factors for both PM and PPC at SL. A risk score was produced for both PM and PPC, and then validated internally.

Results: Among 968 patients who underwent SL, 96 (9.9%) had PM and 81 (8.4%) had PPC at SL. Tumour site (p < 0.001), computed tomography (CT) T stage (p < 0.001) and N stage (p = 0.029) were significantly associated with PM at SL (p < 0.001). Tumour site (p < 0.001), biopsy histology (p = 0.041), CT T stage (p < 0.001) and N stage (p < 0.001) were significantly associated with PPC. The risk scoring model for PM included cancer site and CT T stage. This was successfully tested on the validation set (area under the receiver operating characteristic [AUROC] = 0.730). The risk scoring model for PPC included cancer site, CT T and N stage. This was successfully tested on the validation set (AUROC = 0.773).

Conclusions: The current risk scores are valid tools with which to predict the risk PM and PPC in patients undergoing SL for OG cancer and may help to avoid subjecting patients to unnecessary SL.

Keywords: Gastric cancer; Oesophageal cancer; Staging laparoscopy.

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Figures

Figure 1
Figure 1
Flowchart detailing patients included and excluded for this study. Cyt +ve = positive peritoneal cytology; Cyt −ve = negative peritoneal cytology; Met +ve = peritoneal metastases present; Met −ve = peritoneal metastases absent
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve for (a) peritoneal metastases risk score when tested on validation set and (b) positive peritoneal cytology risk score when tested on validation set.
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