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. 2025 Sep 18:28:625-631.
doi: 10.1016/j.xjon.2025.09.010. eCollection 2025 Dec.

The role of diagnostic laparoscopy in staging distal esophageal adenocarcinoma

Stella T Tsui  1 , Nanruoyi Zhou  1 , Kay See Tan  2 , Junting Zheng  2 , Katherine D Gray  1   3 , Smita Sihag  1   3 , Valerie W Rusch  1   3 , Manjit S Bains  1   3 , Bernard J Park  1   3 , Matthew J Bott  1   3 , James Huang  1   3 , Prasad S Adusumilli  1   3 , Laura H Tang  4 , Daniela Molena  1   3 , David R Jones  1   3
Affiliations

The role of diagnostic laparoscopy in staging distal esophageal adenocarcinoma

Stella T Tsui et al. JTCVS Open. .

Abstract

Objectives: The study objectives were to determine whether diagnostic laparoscopy improves staging accuracy in selected patients with distal esophageal adenocarcinoma and to identify clinicopathologic features associated with positive diagnostic laparoscopy.

Methods: Patients with distal esophageal adenocarcinoma who underwent diagnostic laparoscopy from 2000 to 2023 at a single institution were identified from a prospectively maintained surgical database. Exclusion criteria included performance of diagnostic laparoscopy after systemic therapy, absence of staging positron computed tomography/computed tomography, and M1 disease before diagnostic laparoscopy. Fisher exact test and Wilcoxon rank-sum test were used to compare categorical and continuous variables, respectively, between patients with negative and positive diagnostic laparoscopy. Clinicopathologic features were assessed using multivariable logistic regression.

Results: In total, 226 of 2131 patients with distal esophageal adenocarcinoma (11%) underwent diagnostic laparoscopy; 93% of these patients (211/226) had clinical T stage 3 or more. Most patients had clinical stage III disease before diagnostic laparoscopy (205/226 [91%]). In total, 183 patients (81%) had negative diagnostic laparoscopy, and 43 patients (19%) had positive diagnostic laparoscopy. In 40 patients (20%), disease was upstaged from III to IVB after positive diagnostic laparoscopy. Distal esophageal adenocarcinoma with signet ring feature (odds ratio, 2.45, 95% CI, 1.05-5.86; P = .040) was associated with positive diagnostic laparoscopy. Cardia involvement (P = .581), clinical T stage (P > .999), presence of clinical nodal disease (P = .550), clinical stage before diagnostic laparoscopy (P > .999), maximum standardized uptake value (P = .124), and poor differentiation without signet ring feature (P = .341) were not associated with positive diagnostic laparoscopy.

Conclusions: Signet ring feature is associated with peritoneal disease. The use of diagnostic laparoscopy in these patients may lead to better staging and more appropriate treatment strategies.

Keywords: diagnostic laparoscopy; distal esophageal adenocarcinoma; staging laparoscopy.

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Conflict of interest statement

S.T.S. serves on the AstraZeneca advisory board. B.J.P. has received honoraria from Intuitive Surgical, AstraZeneca, and Medtronic, consults for CEEVRA, and has received research support from Intuitive Surgical. M.J.B. consults for AstraZeneca, Iovance Biotherapeutics, and Intuitive Surgical and receives research support from Obsidian Therapeutics. P.S.A. declares research funding from ATARA Biotherapeutics; is a scientific advisory board member and consultant for ATARA Biotherapeutics, Bayer, Bio4T2, Carisma Therapeutics, Imugene, ImmPactBio, Johnson & Johnson, Orion, and Outpace Bio; has patents, royalties, and intellectual property on T-cell therapies licensed to ATARA Biotherapeutics; and has an issued patent method for detection of cancer cells using virus and pending patent applications on PD-1 dominant negative receptor, a wireless pulse-oximetry device, and an ex vivo malignant pleural effusion culture system. D.M. serves on a steering committee for AstraZeneca, consults for Johnson & Johnson, Bristol-Myers Squibb, AstraZeneca, and Boston Scientific, and has been an invited speaker for Merck and Genentech. D.R.J. serves on an advisory council for AstraZeneca and receives research grant support from Merck. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Signet ring feature is strongly associated with positive DL.
Figure 1
Figure 1
CONSORT diagram demonstrating the results of DL for 43 patients with distal esophageal adenocarcinoma who had a positive staging laparoscopy and the treatment plan for our study group.
Figure 2
Figure 2
CONSORT diagram showing the results of DL for 14 patients with distal esophageal adenocarcinoma with an initial positive staging laparoscopy.
Figure 3
Figure 3
Design and results of the study.
See this image and copyright information in PMC

References

    1. Verstegen M.H.P., Harker M., van de Water C., et al. Metastatic pattern in esophageal and gastric cancer: influenced by site and histology. World J Gastroenterol. 2020;26(39):6037–6046. - PMC - PubMed
    1. Mezhir J.J., Shah M.A., Jacks L.M., Brennan M.F., Coit D.G., Strong V.E. Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Indian J Surg Oncol. 2011;2(1):16–23. - PMC - PubMed
    1. Koemans W.J., Lurvink R.J., Grootscholten C., Verhoeven R.H.A., de Hingh I.H., van Sandick J.W. Synchronous peritoneal metastases of gastric cancer origin: incidence, treatment and survival of a nationwide Dutch cohort. Gastric Cancer. 2021;24(4):800–809. - PubMed
    1. Rudiger Siewert J., Feith M., Werner M., Stein H.J. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg. 2000;232(3):353–361. - PMC - PubMed
    1. Bentrem D., Wilton A., Mazumdar M., Brennan M., Coit D. The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection. Ann Surg Oncol. 2005;12(5):347–353. - PubMed

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