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Yield of Staging Laparoscopy and Lavage Cytology for Radiologically Occult Peritoneal Carcinomatosis of Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to identify the yield of staging laparoscopy with peritoneal lavage cytology for gastric cancer patients and to track it over time.

Methods

The medical records of patients with gastric or gastroesophageal adenocarcinoma who underwent pretreatment staging laparoscopy at the authors’ institution from 1995 to 2012 were reviewed. The yield of laparoscopy was defined as the proportion of patients who had positive findings on laparoscopy, including those with macroscopic carcinomatosis, positive cytology, or other clinically important findings. To compare the yield of laparoscopy over time, the patients were divided into three 6-year ranges based on the date of diagnosis. Associations between clinicopathologic factors and peritoneal disease were examined using uni- and multivariate analyses.

Results

The study included 711 patients. Among these patients, 43.5 % had gastroesophageal junction tumors, 72.9 % had poorly differentiated adenocarcinoma, and 53 % had signet ring cell morphology. Endoscopic ultrasound had most commonly identified T3 (83.9 %) and N-positive (66.4 %) tumors. At laparoscopy, 148 (20.8 %) patients had been found to have macroscopic peritoneal carcinomatosis. Among 514 macroscopically negative patients who underwent peritoneal lavage cytologic analysis, 68 (13.2 %) had positive cytology results for malignancy. The total laparoscopy yield was 36 %, which did not change over time (p = 0.58). Multivariate analysis demonstrated that positive cytology or carcinomatosis was associated with poorly differentiated histology, linitis plastica, and equivocal computed tomography findings.

Conclusions

Laparoscopy remains a useful staging procedure to evaluate for peritoneal spread when treatment or surgery is considered, even with the current availability of high-quality imaging.

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Acknowledgment

The authors thank Amy Ninetto, PhD, for scientific editing.

Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Naruhiko Ikoma MD, Yi-Ju Chiang MSPH, Keith Fournier MD, Paul Mansfield MD & Brian D. Badgwell MD, MS

  2. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela Blum MD & Jaffer A. Ajani MD

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella MD & Sinchita Roy-Chowdhuri MD

Authors
  1. Naruhiko Ikoma MD
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  2. Mariela Blum MD
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  3. Yi-Ju Chiang MSPH
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  4. Jeannelyn S. Estrella MD
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  5. Sinchita Roy-Chowdhuri MD
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  6. Keith Fournier MD
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  7. Paul Mansfield MD
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  8. Jaffer A. Ajani MD
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  9. Brian D. Badgwell MD, MS
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Corresponding author

Correspondence to Brian D. Badgwell MD, MS.

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Ikoma, N., Blum, M., Chiang, YJ. et al. Yield of Staging Laparoscopy and Lavage Cytology for Radiologically Occult Peritoneal Carcinomatosis of Gastric Cancer. Ann Surg Oncol 23, 4332–4337 (2016). https://doi.org/10.1245/s10434-016-5409-7

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  • DOI: https://doi.org/10.1245/s10434-016-5409-7

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