Efficacy of staging laparoscopy for type 4 and large type 3 gastric cancer

Background

In patients with advanced gastric cancer, staging laparoscopy (SL) is regarded as a useful procedure for detecting minute peritoneal metastasis, which is difficult to identify by conventional imaging modalities. However, indications for the procedure differ across reports and remain unclear. Infiltrative type gastric cancers could be suitable candidates for SL because of the high risk of peritoneal metastasis. The present study aimed to clarify the effectiveness and limitations of SL for patients with type 4 and large type 3 gastric cancers.

Methods

We included 140 consecutive patients with cM0, type 4 or large type 3 (8cm or larger in diameter) gastric cancer who underwent SL at the Shizuoka Cancer Center from August 2008 to December 2015. Patients who received chemotherapy before the SL were excluded. We determined the detection rate of peritoneal metastasis by SL, and calculated the false negative rate of SL by recruiting patients who were diagnosed as P0 at SL and underwent laparotomy within 28 days after the SL.

Results

P0CY0, P0CY1, P1CY0, and P1CY1 were diagnosed in 64 (45.7%), 29 (20.7%), 16 (11.4%), and 31 (22.1%) patients, respectively. Accordingly, clinically non-evident peritoneal metastasis was found in 33.6% of patients, and 54.3% of patients were diagnosed as stage IV. In addition, 51 patients diagnosed as P0 at SL underwent laparotomy within 28 days after the SL. Among them, peritoneal metastasis was found in seven patients. Thus, the false negative rate was 13.7% (7/51).

Conclusions

SL is useful for detecting previously unsuspected peritoneal metastasis and for avoiding unnecessary laparotomy, although the high false negative rate cannot be ignored. Peritoneal metastasis was found by SL in approximately one third of patients with cM0, type 4 and large type 3 gastric cancers, and therefore, they are considered suitable candidates for SL.

Clinical trial identification

Legal entity responsible for the study

Masanori Tokunaga

Funding

Shizuoka Cancer Center

Disclosure

All authors have declared no conflicts of interest.