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Laparoscopy and peritoneal cytology: important prognostic tools to guide treatment selection in gastric adenocarcinoma
Author(s) -
Tourani Saam S.,
Cabalag Carlos,
Link Emma,
Chan Steven T. F.,
Duong Cuong P.
Publication year - 2013
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12197
Subject(s) - medicine , occult , laparoscopy , cytology , radiology , adenocarcinoma , general surgery , cancer , pathology , alternative medicine
Abstract Background Previous studies have suggested that patients with occult peritoneal metastases not seen on preoperative imaging have poor prognosis. In this study, we aim to evaluate the utility and impact of staging laparoscopy and peritoneal cytology in patients with gastric adenocarcinoma. Methods A retrospective analysis of patients with gastric adenocarcinoma managed at two major metropolitan hospitals in M elbourne, A ustralia, between J anuary 1999 and J uly 2010 was undertaken. The main outcome measures were the number of patients in whom laparoscopy and/or peritoneal cytology changed treatment intent, and the overall survival of patients with occult metastases detected by laparoscopy/cytology. Results Staging laparoscopy as an independent procedure was performed in 74.3% (148/199) of patients who had neither unequivocal metastases ( M 1) on preoperative imaging nor early T 1 disease on endoscopic ultrasound. Laparoscopy/cytology detected occult metastases in 38 (25.6%) patients (27 macroscopic M 1 and 11 microscopic M 1 with positive peritoneal cytology only), leading to change in the treatment intent in 37 cases. The median overall survivals of patients with metastatic disease detected at staging laparoscopy (8.3 months, 95% confidence interval ( CI ) 5.4–16.5) or on peritoneal cytology (4.9 months, 95% CI 4.2–48) were as poor as those with M 1 disease seen on preoperative imaging (6.7 months, 95% CI 4.2–8.9), P = 0.97. Conclusions Laparoscopy and peritoneal cytology add incremental value to modern imaging in the staging of gastric adenocarcinomas by detecting occult metastatic disease. Their utility needs to be optimized to allow better treatment selection for gastric cancer patients.