Clinical utility of perioperative staging laparoscopy for advanced gastric cancer

World Journal of Surgical Oncology

Shoji Natsugoe¹  Kosei Maemura¹  Akihiro Nakajo¹  Yuko Kijima¹  Hiroshi Kurahara¹  Yoshiaki Kita¹  Yasuto Uchikado¹  Hiroshi Okumura¹  Shigehiro Yanagita¹  Takaaki Arigami¹  Yoshikazu Uenosono¹  Sumiya Ishigami¹ 

[1] Department of Digestive Surgery, and Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan

关键词: Staging laparoscopy;    Gastrectomy;    Peritoneal metastasis;   

Others  :  1147253
DOI  :  10.1186/1477-7819-12-350

 received in 2013-07-23, accepted in 2014-10-03,  发布年份 2014

【 摘 要 】

Background

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.

Methods

A 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.

Results

Curative 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.

Conclusions

Occult 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.

【 授权许可】

   
2014 Ishigami et al.; licensee BioMed Central Ltd.

【 图 表 】

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