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J Surg Oncol. 2018 Jul;118(1):61-67. doi: 10.1002/jso.25094. Epub 2018 Jun 7.

Repeat staging laparoscopy for gastric cancer after preoperative therapy.

Author information

1
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
2
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Abstract

BACKGROUND AND OBJECTIVES:

Staging laparoscopy is recommended before preoperative therapy in patients with locoregional gastric cancer, but yield of repeated diagnostic laparoscopy at the time of resection is unknown.

METHODS:

Retrospective review of a prospective database of patients with gastric adenocarcinoma (1994-2016) who had negative staging laparoscopy followed by preoperative therapy and subsequent attempted resection. Primary outcome was positive exploration (peritoneal or unresectable disease) at the time of resection. Multivariable logistic regression identified factors associated with positive exploration.

RESULTS:

Of the 451 patients with attempted resection, 54 (12.0%) had positive explorations, including 48 with peritoneal disease. Patients with positive explorations were more likely to be female and have poorly differentiated tumors, linitis features, and signet-ring morphology. There was no significant difference by exploration results in age, race, clinical stage, or delayed definitive surgery. Positive explorations were independently associated with poor differentiation (OR 4.6, 95%CI 1.4-15.3; P = 0.01) and linitis (OR 4.2, 95%CI 1.9-9.2; P < 0.001). Positive explorations were seen in 14.0% of patients with poor differentiation, 36.6% of patients with linitis, and 5.8% of patients with neither linitis nor poor differentiation.

CONCLUSION:

Despite negative pretreatment laparoscopy, post-treatment repeat laparoscopy may prevent non-therapeutic laparotomies. At a minimum, we recommend selective repeat laparoscopy for patients with linitis features.

KEYWORDS:

gastric cancer; laparoscopy; neoadjuvant; preoperative therapy; staging

PMID:
29878364
DOI:
10.1002/jso.25094
[Indexed for MEDLINE]

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