Accuracy of staging laparoscopy in detecting peritoneal dissemination in patients with gastroesophageal adenocarcinoma

Abstract

Despite staging laparoscopy (SL) with peritoneal lavage is recommended in US Guidelines in patients with potentially resectable gastroesophageal adenocarcinoma, this procedure is not systematically proposed in French Guidelines. Therefore, we decided to analyze the results of systematic SL in patients considered for preoperative chemotherapy. From 2005 to 2011, 116 consecutive patients with distal esophagus, esogastric junction, and gastric adenocarcinoma ≥T3 or N+ without detectable metastatic dissemination by computed tomography (CT) scan imaging underwent SL before neoadjuvant chemotherapy. Positive and negative SLs were compared according to tumor characteristics. SL was positive in 15 cases (12.9%) including 14 with peritoneal seeding (localized in five, diffuse in nine). SL was positive in 7 (24.1%) of 29 patients with poorly differentiated tumor, in 9 (32.1%) of 28 patients with signet ring cells, in 7 (50%) of 14 patients with gastric linitis tumor, and in 15 (16.3%) of 92 patients with T3 or T4 tumor. All the lesions of distal esophagus extending to the cardia had a negative SL. Among the 14 patients with peritoneal carcinomatosis at SL, nine (65%) had signs of peritoneal seeding on initial CT scan. One (0.8%) patient had a small bowel perforation closed laparoscopically. If systematic SL before preoperative chemotherapy does not seem justified because of its low accuracy, it should be performed in patients with poorly differentiated tumor, signet ring cell, and gastric linitis plastica components on biopsy and when CT scan is suggestive of T4 tumor, ascites, or peritoneal nodule.

Role of staging laparoscopy for gastric cancer patients

“…Irino et al, Hosogi et al, Miki et al, Ishigami et al, Yamagata et al and Nakagawa et al reported the detection rate of P1 and/or CY1 as 47%, 45%, 53.4%, 42.7%, 46% and 51.6%, respectively. Results of these studies from Japanese institutions were almost similar (range: 42.7% to 53.4%), and higher than those from other countries (range: 7.8% to 40%) . The reason for this discrepancy was the difference in the indication for SL.…”

“…Staging laparoscopy is considered a safe procedure carried out within one hour under general anesthesia. Some reported intestinal injury during SL . In many reports, there were no SL‐related complications (Table ), but the estimated SL‐related complication rate was 0.4% based on total accumulated data.…”

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

“…Auch bei makroskopisch unauffälliger Staging-Laparoskopie ohne Nachweis von peritonealen Metastasen ist beim lokal fortgeschrittenen Magenkarzinom oder Karzinom des ösophagogastralen Übergangs (AEG) mit einer positiven Zytologie zu rechnen [366]. Deshalb sollte die Peritoneallavage mit Zytologie ein integraler Bestandteil der diagnostischen Laparoskopie vor Therapieentscheid sein und in standardisierter Technik vorgenommen werden [367]. Die Ergebnisse von Patienten mit Magenkarzinom und positiver Zytologie in der Peritoneallavage unterscheiden sich derzeit durch diagnostische Methoden aufgrund der quantitativen und qualitativen Diversität der Tumorzellen.…”

Diagnostic staging laparoscopy in gastric cancer treatment: A cost‐effectiveness analysis

“…Both modalities lack sensitivity to detect small peritoneal or liver metastases and may miss metastases in 13‐41% of patients . Diagnostic staging laparoscopy (DSL) is a staging modality that allows for direct visualization of the peritoneum, liver, and abdominal cavity, and can be performed when CT and EUS are negative or inconclusive in order to identify radiographically occult metastases …”