Abstract
BackgroundPerioperative staging laparoscopy is a useful tool for the detection of occult peritoneal metastases in gastrointestinal cancers. This retrospective study aimed to determine the clinical value of staging laparoscopy for advanced or recurrent gastric cancer.MethodsA total of 178 patients with advanced or recurred gastric cancer who underwent perioperative staging laparoscopy were enrolled. In the absence of peritoneal deposits (P1) and positive peritoneal cytology (CY1), gastrectomy with lymph node dissection was indicated with curative intent. If P1 or CY1 was detected intraoperatively, patients received intensive chemotherapy and laparoscopic surgical intervention.ResultsCurative gastrectomy was performed in 104 patients after confirmation of P0 and CY0 status. P1 or CY1 was detected for the first time in 23 (15%) patients. A total of 13 patients were converted from gastrectomy to intensive chemotherapy after detection of P1 or CY1. Additional laparoscopic interventions included insertion of intraperitoneal reservoir port in 54 patients, insertion of a metallic stent in five, ileostomy for colon stricture in six, jejunostomy in 19, and gastrojejunostomy in 16. Of eight patients treated with intensive chemotherapy who underwent R0 gastrectomy after second-look laparoscopy, five are currently free from recurrence of gastric cancer for 25.5 months.ConclusionsOccult peritoneal dissemination was detected in about 14% in patients with tumors deeper than T2. Moreover, additional laparoscopic interventions can be utilized for P1 or CY1 patients. The excellent surgical outcomes of R0 gastrectomy after chemotherapy and second-look laparoscopy indicate that confirmation of P0 and CY0 status by staging laparoscopy is of value to determine treatment strategy in patients with advanced gastric cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/1477-7819-12-350) contains supplementary material, which is available to authorized users.
Highlights
Perioperative staging laparoscopy is a useful tool for the detection of occult peritoneal metastases in gastrointestinal cancers
Since June 2002, perioperative staging laparoscopy has been used at our institution to determine whether complete resection (R0) gastrectomy or less invasive surgical intervention is indicated in patients with advanced gastric cancer
Thirteen patients were converted from gastrectomy to intensive chemotherapy after detection of positive peritoneal metastases (P1) or positive cytology (CY1)
Summary
Perioperative staging laparoscopy is a useful tool for the detection of occult peritoneal metastases in gastrointestinal cancers. This retrospective study aimed to determine the clinical value of staging laparoscopy for advanced or recurrent gastric cancer. With the improvements in laparoscopic instruments and techniques, gastrectomy with lymph node dissection has become a popular procedure among gastrointestinal surgeons [11] These advances have improved the accuracy of staging laparoscopy and have enabled the detection of intra-abdominal deposits by intraoperative pathological examination. Since June 2002, perioperative staging laparoscopy has been used at our institution to determine whether R0 gastrectomy or less invasive surgical intervention is indicated in patients with advanced gastric cancer. The present study is a retrospective analysis of the clinical outcomes of this series and a discussion of the clinical implications of perioperative staging laparoscopy
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