Staging Laparoscopy is Underutilized in the Management of Gastric Adenocarcinoma

Groh, Eric; Gupta, Shreya; Brown, Zachary J.; Enewold, Lindsey; Gamble, Lauren A.; Hernandez, Jonathan M.; Davis, Jeremy L.

doi:10.1245/s10434-019-08077-1

Cited by 16 publications

(25 citation statements)

References 14 publications

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“…Despite the proven value of SL in the diagnosis of PM, there is no consensus yet on its routine use in clinical practice, and it remains underutilized in the management of GC, with reported frequencies of less than 25%. [22][23][24][25][26] Thus, the present study was developed to further address this issue and to highlight the importance of SL in the diagnosis of PM and treatment strategy. In our study, of the 130 patients submitted to SL, PM was found in 66 (50.76%).…”

Section: Discussionmentioning

confidence: 99%

Staging Laparoscopy Is Still a Valuable Tool for Optimal Gastric Cancer Management

Sakamoto

Ramos

Pereira

et al. 2021

Preprint

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Purpose: Complete surgical resection is the main determining factor in the survival of advanced gastric cancer (AGC) patients, but resection should be avoided in metastatic disease. Peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect peritoneal metastasis (PM). Thus, the aim of this study was to evaluate the role of Staging Laparoscopy (SL) in the staging of AGC patients in a Western tertiary cancer center. Methods: We reviewed 130 patients with gastric adenocarcinoma submitted to SL from 2009 to 2020 from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of PM. We also evaluated the accuracy and strength of agreement between computed tomography (CT) and SL in detecting PM, and the change in treatment strategy after SL. Results: Among the 130 patients, PM was identified in 66 patients (50.76%) - P1 group. The sensitivity, specificity and accuracy of CT in detecting PM were 51,5%, 87,5% and 69.2%, respectively. According to the Kappa coefficient, concordance between SL and CT was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected PM on CT scan (p=0.007) were statistically correlated with the P1 group. In 40 patients (30.8%), staging and treatment plans changed after SL (32 patients avoided unnecessary laparotomy and 8 patients who were previously considered stage IVb by CT scan were referred for surgical treatment). Conclusions: Even with current advances in imaging techniques, SL demonstrated an important role in the diagnosis of PM and remains valuable for determining the correct therapeutic strategy.

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Section: Discussionmentioning

confidence: 99%

Staging Laparoscopy Is Still a Valuable Tool for Optimal Gastric Cancer Management

Sakamoto

Ramos

Pereira

et al. 2021

Preprint

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“…Furthermore, the percentage found in this study (10%) does not completely support these previously published numbers. 8,[33][34][35] An explanation for this might be that peritoneal lavage is also included in the aforementioned studies and scored as positive SL, whereas in the current dataset, neither information on whether peritoneal lavage has been performed nor outcomes of the SL are registered. In our study, no differences were found in the number of intraoperatively determined non-curative procedures when comparing the performance of no, solely one, or both staging modalities; however, it should be noted that this was analyzed during the implementation phase of the guideline.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Implementation of FDG-PET/CT and Staging Laparoscopy for Gastric Cancer in The Netherlands

et al. 2020

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Background The role of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) has increased in the preoperative staging of gastric cancer. Dutch national guidelines have recommended the use of FDG-PET/CT and SL for patients with locally advanced tumors since July 2016. Objective The aim of this study was to evaluate the implementation of FDG-PET/CT and SL in The Netherlands. Methods Between 2011 and 2018, all patients who underwent surgery for gastric cancer were included from the Dutch Upper GI Cancer Audit. The use of FDG-PET/CT and SL was evaluated before and after revision of the Dutch guidelines. Outcomes included the number of non-curative procedures (e.g. palliative and futile procedures) and the association of FDG-PET/CT and SL, with waiting times from diagnosis to the start of treatment. Results A total of 3310 patients were analyzed. After July 2016, the use of FDG-PET/CT (23% vs. 61%; p < 0.001) and SL (21% vs. 58%; p < 0.001) increased. FDG-PET/CT was associated with additional waiting time to neoadjuvant therapy (4 days), as well as primary surgical treatment (20 days), and SL was associated with 8 additional days of waiting time to neoadjuvant therapy. Performing SL or both modalities consecutively in patients in whom it was indicated was not associated with the number of non-curative procedures. Conclusion During implementation of FDG-PET/CT and SL after revision of the guidelines, both have increasingly been used in The Netherlands. The addition of these staging methods was associated with increased waiting time to treatment. The number of non-curative procedures did not differ after performing none, solely one, or both staging modalities.

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Section: Staging Laparoscopymentioning

confidence: 99%

“…Historically, diagnostic laparoscopy has been underutilized in the staging of gastric cancer (2). A SEER database study of all resected gastric cancer patients from 2004-2013 found that only 13% (n=733/5,610) underwent staging laparoscopy (2). Despite this, a quarter of gastric cancer patients undergoing staging laparoscopy can have positive peritoneal cytology (3).…”

Section: Staging Laparoscopymentioning

confidence: 99%

Advances in the surgical management of gastric and gastroesophageal junction cancer

Narayan¹,

Poultsides²

2021

Transl Gastroenterol Hepatol

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Since Theodore Billroth and Cesar Roux perfected the methods of post-gastrectomy reconstruction in the late 19 th century, surgical management of gastric and gastroesophageal cancer has made incremental progress. The majority of patients with localized disease are treated with perioperative combination chemotherapy or neoadjuvant chemoradiation. Staging laparoscopy before initiation of treatment or before surgical resection has improved staging accuracy and can drastically inform treatment decisions. The longstanding and contentious debate on the optimal extent of lymph node dissection for gastric cancer appears to have settled in favor of D2 dissection with the recently published 15-year followup of the Dutch randomized trial. Minimally invasive gastric and gastroesophageal resections are performed routinely in most centers affording faster recovery and equivalent oncologic outcomes. Pylorus-preserving distal (central) gastrectomy has emerged as a less invasive, function-preserving option for T1N0 middlethird gastric cancers, while randomized data on its oncologic adequacy are pending. Multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been utilized selectively for patients with locally advanced tumors who have demonstrated disease control on preoperative chemotherapy.This review summarizes the current standard of surgical care for gastroesophageal junction and gastric cancer as well as highlights recent and upcoming advances to the field.

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Staging Laparoscopy is Underutilized in the Management of Gastric Adenocarcinoma

Cited by 16 publications

References 14 publications

Staging Laparoscopy Is Still a Valuable Tool for Optimal Gastric Cancer Management

Staging Laparoscopy Is Still a Valuable Tool for Optimal Gastric Cancer Management

Evaluation of the Implementation of FDG-PET/CT and Staging Laparoscopy for Gastric Cancer in The Netherlands

Advances in the surgical management of gastric and gastroesophageal junction cancer

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