Techniques of staging laparoscopy and peritoneal fluid assessment in gastric cancer: a systematic review

Abstract

Background: Staging laparoscopy for gastric cancer is recommended to assess the tumor’s locoregional extension and exclude peritoneal disease. As there is no consensus on optimizing the procedure’s diagnostic accuracy, we aimed to systematically review the literature on operative techniques, followed by peritoneal lavage fluid assessment in gastric cancer patients. Specifically, we sought to indicate the most common characteristics of the procedure and cytological evaluation. Methods: This study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The protocol for this systematic review was registered on PROSPERO database (CRD: 42022306746). On September 2022, a search was carried out using Embase, Medline ALL, Cochrane Central Register of Controlled Trials and Web of Science Core Collection. Results: The search identified 1632 studies on staging laparoscopy and 2190 studies on peritoneal fluid assessment. Some 212 studies were included. Open Hasson was the method of choice in accessing the peritoneal cavity in 65% of the studies, followed by establishing a pneumoperitoneum at 10-12mmHg in 52% of reports. Most frequently, the patient was positioned supine (70%), while a 30° scope and three ports were used to assess the peritoneal cavity clockwise (72%, 77%, and 85%, respectively). Right and left upper abdomen quadrants were the predominant area of laparoscopic exploration (both 65%), followed by primary tumor region (54%), liver and pelvis (both 30%), small bowel and spleen (19% and 17%, respectively). Regions of peritoneal lavage and aspiration were limited to pelvis (50%), followed by right and left upper abdomen quadrants (37.5% and 50%, respectively). No studies compared different methods of operative techniques or analysis of ascites/fluid. Conclusions: This study indicates a high heterogeneity in the technique of staging laparoscopy and peritoneal fluid assessment in gastric cancer patients. Further research and initiatives to reach a consensus on the standardization of the procedure are warranted.

Textbook Neoadjuvant Outcome—Novel Composite Measure of Oncological Outcomes among Gastric Cancer Patients Undergoing Multimodal Treatment

“…Pos-sibly, with the advancement of computing power and graphic processing technologies [53], artificial intelligence (AI) techniques demonstrate the potential to enhance CT by providing more accurate staging and restaging of the GC along with improved detection of recurrence and progression of the disease [54]. To address shortcomings of CT, staging laparoscopy (SL) is a recommended complementary diagnostic method in potentially resectable GC, preventing 25% of irrelevant gastrectomies [14,55]. Although SL has limited abdominal cavity exploration, the procedure yield exceeds 36%, with lavage cytology further improving the detection of radiologically occult peritoneal metastasis [56,57].…”

“…Moreover, SL maintains its sensitivity independently of lymph node involvement, and its yield has remained consistent over time despite improvements in imaging techniques. A recent Systematic Review indicated a high heterogeneity in procedure technique [55], and there is no consensus on whether to perform repeated SL after NAC as well. However, given the increased rate of minimally invasive gastrectomy in the West, performing laparoscopy with intraoperative decision to pursue with curative intent gastrectomy, may condition further assessment of surgical textbook outcomes.…”