Staging Laparoscopy for Patients with cM0, Type 4, and Large Type 3 Gastric Cancer

Miki, Yuichiro; Tokunaga, Masanori; Takeda, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Terashima, Masanori

doi:10.1007/s00268-015-3144-z

Cited by 44 publications

(39 citation statements)

References 29 publications

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“…The main purpose of SL was to find disseminated nodules that could not be detected by imaging, but other clinical findings that could change the therapeutic strategy (such as liver metastases or invasion to adjacent organs) may be detected at SL. 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%) .…”

Section: Resultsmentioning

confidence: 99%

“…We also questioned whether the total length of mesentery must be inspected. Ishigami et al and Miki et al included “the surface of the entire bowel” and “from the oral to anal side “in the exploration area of SL, but there was no description in other reports. Definite answers could not be drawn from the reported articles, but wide exploration may be needed to reduce false‐negative results.…”

Section: Resultsmentioning

confidence: 99%

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Role of staging laparoscopy for gastric cancer patients

Fukagawa

2019

Annals of Gastroent Surgery

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Staging laparoscopy (SL) is frequently carried out in patients with advanced gastric cancer. However, some clinical questions are being debated and consensus must be obtained. With this aim, a literature search of PubMed/MEDLINE was carried out using the keywords “gastric cancer,” “SL,” and “diagnostic laparoscopy”. Articles published online up to February 2019 were analyzed, focusing on the following questions. (i) What is an adequate indication for SL? (ii) How do you carry out SL? (iii) Does SL provide accurate information about peritoneal dissemination? (iv) Is the yield of SL different by tumor location? (v) Is SL a safe procedure? (vi) Is “repeat SL” needed? (vii) Does SL provide oncological benefit? Results provided the following responses: (i) In Western countries, clinically resectable advanced tumor is an indication for SL. Terms to be introduced for adequate indication include “location,” “type 4 (linitis feature),” “large tumor,” “equivocal computed tomography (CT] findings,” and “lymph node swelling”. (ii) Exploration of the entire peritoneal cavity is preferable. (iii) Detection rate of peritoneal disease is 43%‐52% in Japanese institutions and 7.8%‐40% in other countries. False‐negative findings during SL were 0%‐17%, and 10%‐13% when limited to cytology. (iv) Yield of SL was higher in gastric cancer compared with esophagogastric junctional tumor. (v) SL‐related complications were estimated to occur in 0.4%. (vi) Repeat SL is important after treatment. (vii) If the efficacy of neoadjuvant chemotherapy for patients with P0CY1 is established, SL can provide oncological benefit. SL can be carried out safely and effectively. Considering the prevalence of neoadjuvant treatment, the role of SL will become more important.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Role of staging laparoscopy for gastric cancer patients

Fukagawa

2019

Annals of Gastroent Surgery

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“…Second, preoperative staging without staging laparoscopy could have resulted in over-staging, particularly in cases of peritoneal seeding. Diagnostic staging laparoscopy and re-evaluation of peritoneal metastasis with staging laparoscopy might be helpful in improving the diagnostic accuracy and optimizing candidates for conversion surgery [26,27]. Third, the clinical efficacy of cancer dormancy marker expression in conversion surgery cannot be definitively concluded, given the relatively small sample size of this study.…”

Section: Discussionmentioning

confidence: 92%

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Choe

Kim

Han

et al. 2019

Cancers

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The role of conversion surgery in metastatic gastric cancer remains unclear. Cancer dormancy markers might have a role in predicting the survival in patients with conversion surgery. We identified 26 patients who went through conversion surgery, i.e., a curative-intent gastrectomy with metastasectomy after chemotherapy in initially metastatic gastric cancer. As controls, 114 potential candidates for conversion surgery who only received chemotherapy were included for the propensity score matching. Conversion surgery showed a significantly longer overall survival (OS) compared with only palliative chemotherapy (median-43.6 vs. 14.0 months, respectively, p < 0.001). This better survival in the conversion surgery group persisted even after propensity matching (p < 0.001), and also when compared to patients with tumor response over 5.1 months in the chemotherapy only group (p = 0.005). In the conversion surgery group, OS was longer in patients with R0 resection (22/26, 84.6%) than without R0 resection (4/26, 15.4%) (median-not reached vs 22.1 months, respectively, p = 0.005). Although it should be interpreted with caution due to the primitive analysis in a small population, the positive expression of NR2F1 showed a longer duration of disease-free survival (DFS) after conversion surgery (p = 0.016). In conclusion, conversion surgery showed a durable OS even in patients with initially metastatic gastric cancer when R0 resection was achieved after chemotherapy.

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“…Identifying patients at higher risk of nonperitoneal recurrence after curative gastrectomy could provide survival benefit to patients by offering more intensive postoperative follow-up, on the basis of our present findings. It is well known that undifferentiated-type and serosa-invasive adenocarcinoma is frequently associated with peritoneal recurrence [24], whereas differentiated-type adenocarcinoma is related to nonperitoneal recurrence [25]. If we can predict a similar recurrence pattern with high accuracy, we could offer the most suitable follow-up schedule to each patient accordingly.…”

Section: Discussionmentioning

confidence: 99%

Early detection of nonperitoneal recurrence may contribute to survival benefit after curative gastrectomy for gastric cancer

et al. 2016

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Background There is no evidence that strict follow-up using cross-sectional imaging after curative gastrectomy benefits survival; however, nonperitoneal recurrence detected early might be treated with additional surgery. The present study examined whether early detection of recurrence by imaging modalities could increase survival, particularly in patients with nonperitoneal recurrence. Methods We retrospectively analyzed 218 patients with recurrent gastric cancer after curative gastrectomy performed from 2002 to 2014. The patients were divided into an asymptomatic group (n = 117) and a symptomatic group (n = 101), according to the presence of symptoms at the time of recurrence, to compare clinicopathological characteristics and long-term survival. Results Peritoneal recurrence was less frequent in the asymptomatic group (22.2%) than in the symptomatic group (62.4%), the median time to recurrence was shorter (12.7 months vs 18.9 months; P \ 0.001), and the median survival time after recurrence was longer (18.7 months vs 7.5 months; P \ 0.001). In the asymptomatic group, 10 of 117 patients (8.5%) received additional curative surgery after recurrence. Median overall survival after gastrectomy was not significantly different between the groups (30.1 months for the asymptomatic group vs 30.0 months for the symptomatic group; P = 0.132); however, it was significantly longer among asymptomatic patients with nonperitoneal recurrence compared with symptomatic patients (35.9 months vs 24.0 months; P = 0.039). Conclusions The presence of symptoms at recurrence did not affect survival in patients with recurrent gastric cancer. However, detection of nonperitoneal recurrence before the appearance of symptoms may provide survival benefit. Therefore, regular follow-up, including use of imaging modalities, is recommended.

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Staging Laparoscopy for Patients with cM0, Type 4, and Large Type 3 Gastric Cancer

Abstract: SL is useful for detecting previously unsuspected peritoneal metastasis and for avoiding unnecessary laparotomy, although the high false-negative rate cannot be ignored. Patients with cM0, type 4, and large type 3 gastric cancer are considered suitable candidates for SL.

Cited by 44 publications

References 29 publications

Role of staging laparoscopy for gastric cancer patients

Role of staging laparoscopy for gastric cancer patients

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Early detection of nonperitoneal recurrence may contribute to survival benefit after curative gastrectomy for gastric cancer

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