Staging laparoscopy with cytology analysis in gastric cancer.

Abstract

35 Background: The purpose of this study was to identify clinicopathologic factors associated with the identification of peritoneal disease in patients with gastric cancer and to compare the yield of laparoscopy over time. Methods: The medical records of 7,404 patients with gastric or gastroesophageal adenocarcinoma presenting to our institution (1/1995 to 12/2012) were reviewed to identify patients who underwent diagnostic laparoscopy as a staging procedure before treatment. Associations between clinicopathologic factors and peritoneal disease were examined with chi square and logistic regression analysis. The yield on laparoscopy was stratified according to time. Results: We identified 880 patients who underwent staging laparoscopy for gastric adenocarcinoma. Excluded patients included those with recurrent gastric cancer, those who underwent prior chemotherapy and/or radiation therapy, those with known distant metastatic disease (except for equivocal radiological findings), and those who underwent procedures not for staging purposes, leaving 711 patients in this study: 43.5% with gastroesophageal junctional tumors, 72.9% with poorly differentiated adenocarcinoma, and 53.0% with signet ring cell morphology. Endoscopic ultrasound (EUS) most commonly identified T3 (83.9%) and N-positive (66.4%) tumors. As results of laparoscopy, 148 patients (20.8%) were found to have macroscopic peritoneal carcinomatosis. Among 514 macroscopically negative patients who had peritoneal lavage cytology analysis, 68 (13.2%) were found to have positive. Of the 711 study patients, 42 (5.9%) had other unexpected clinically important findings (e.g., distant metastasis, cirrhosis). Multivariate analysis showed a high positive rate of laparoscopy in patients with poorly differentiated pathology, linitis plastica, or equivocal CT scan, after adjusting race, signet ring cell, and tumor location. The yield of laparoscopy did not change over time when divided into three 6-year periods (p = 0.58). Conclusions: Laparoscopy remains an important staging procedure to evaluate for peritoneal spread when considering treatment or surgery, even in the current era of high-quality imaging evaluation.