Diagnostic Staging Laparoscopy in Gastric Cancer: a Prospective Cohort at a Cancer Institute in Japan

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2017 Jul 1

PMID 28664424

Citations 24

Authors

Tomoyuki Irino

Takeshi Sano

Naoki Hiki

Manabu Ohashi

Souya Nunobe

Koshi Kumagai

Satoshi Ida

Toshiharu Yamaguchi

Affiliations

Soon will be listed here.

Abstract

Background: There have been many studies that describe the value of diagnostic staging laparoscopy (DSL) in gastric cancer. However, different studies use different indications, making study results difficult to compare. This study aimed to clarify the diagnostic feasibility of DSL for gastric cancer in a prospective manner and investigated the impact of DSL on clinical decision-making in gastric cancer treatment.

Methods: The study was a prospective cohort study based at a single institution between January 2010 and December 2013. We treated 2213 patients with potentially resectable gastric cancer during this period. DSL was primarily indicated for asymptomatic patients with: (1) large Borrmann type 3 tumours ≥8 cm, (2) Borrmann type 4 tumours (linitis plastica), (3) bulky lymph nodes or paraaortic lymph node swelling, or (4) clinical suspicion of peritoneal disease. The primary outcome is change in treatment strategy, and the secondary outcomes are diagnostic accuracy of the indications and false negative rate of DSL.

Results: DSL was performed on 156 (7%) of 2213 patients. Of these, peritoneal disease was found in 74 (47%) patients: (1) 56% for large type 3, (2) 54% for type 4, (3) 21% for bulky lymph nodes or paraaortic lymph node swelling, and (4) 20% for suspected peritoneal disease. The diagnostic accuracy of our indication for DSL was 92% for all patients and 74% for patients with cT3/T4 tumours. Among 82 patients without peritoneal disease, 66 patients (81%) underwent subsequent radical gastrectomy; peritoneal disease was discovered intraoperatively for 7 patients at laparotomy, indicating a false negative rate of 11%.

Conclusion: We confirmed that DSL performed according to our indication, in the context of gastric cancer, possesses diagnostic feasibility. Approximately half of the patients who underwent DSL consequently avoided unnecessary laparotomy and were able to receive appropriate alternative treatment.

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References

Kim S, Kim H, Kim Y, Hwang S, Lee H, Park D . Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. Radiology. 2009; 253(2):407-15. DOI: 10.1148/radiol.2532082272. View

Kobayashi O, Tsuburaya A, Yoshikawa T, Osaragi T, Murakami H, Yoshida T . The efficacy of gastrectomy for large gastric cancer. Int J Clin Oncol. 2006; 11(1):44-50. DOI: 10.1007/s10147-005-0535-4. View

Smith A, Finch M, John T, Garden O, Brown S . Role of laparoscopic ultrasonography in the management of patients with oesophagogastric cancer. Br J Surg. 1999; 86(8):1083-7. DOI: 10.1046/j.1365-2168.1999.01190.x. View

Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M . Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014; 101(6):653-60. DOI: 10.1002/bjs.9484. View

Roviaro G, Varoli F, Sonnino D, Nucca O, Rabughino G, Scarduelli A . Can routine laparoscopy help to reduce the rate of explorative laparotomies for gastric cancer? Laparoscopy in gastric cancer. Diagn Ther Endosc. 2008; 6(3):125-31. PMC: 2362746. DOI: 10.1155/DTE.6.125. View

. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2016; 20(1):1-19. PMC: 5215069. DOI: 10.1007/s10120-016-0622-4. View

Maruyama K, Okabayashi K, Kinoshita T . Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987; 11(4):418-25. DOI: 10.1007/BF01655804. View

Roviello F, Marrelli D, De Manzoni G, Morgagni P, Di Leo A, Saragoni L . Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg. 2003; 90(9):1113-9. DOI: 10.1002/bjs.4164. View

. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14(2):101-12. DOI: 10.1007/s10120-011-0041-5. View

10.

Fujimura T, Kinami S, Ninomiya I, Kitagawa H, Fushida S, Nishimura G . Diagnostic laparoscopy, serum CA125, and peritoneal metastasis in gastric cancer. Endoscopy. 2002; 34(7):569-74. DOI: 10.1055/s-2002-33228. View

11.

Miki Y, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M . Staging Laparoscopy for Patients with cM0, Type 4, and Large Type 3 Gastric Cancer. World J Surg. 2015; 39(11):2742-7. DOI: 10.1007/s00268-015-3144-z. View

12.

Katayama H, Ito S, Sano T, Takahari D, Mizusawa J, Boku N . A Phase II study of systemic chemotherapy with docetaxel, cisplatin, and S-1 (DCS) followed by surgery in gastric cancer patients with extensive lymph node metastasis: Japan Clinical Oncology Group study JCOG1002. Jpn J Clin Oncol. 2012; 42(6):556-9. DOI: 10.1093/jjco/hys054. View

13.

Nassour I, Fullington H, Hynan L, Yopp A, Augustine M, Polanco P . The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation. Ann Surg Oncol. 2017; 24(7):1787-1794. PMC: 5608608. DOI: 10.1245/s10434-017-5805-7. View

14.

Tapper E, Kalb B, Martin D, Kooby D, Adsay N, Sarmiento J . Staging laparoscopy for proximal pancreatic cancer in a magnetic resonance imaging-driven practice: what's it worth?. HPB (Oxford). 2011; 13(10):732-7. PMC: 3210975. DOI: 10.1111/j.1477-2574.2011.00366.x. View

15.

Emoto S, Ishigami H, Yamashita H, Yamaguchi H, Kaisaki S, Kitayama J . Clinical significance of CA125 and CA72-4 in gastric cancer with peritoneal dissemination. Gastric Cancer. 2011; 15(2):154-61. DOI: 10.1007/s10120-011-0091-8. View

16.

Maehara Y, Oiwa H, Oda S, Sakaguchi Y, Endo K, Ohno S . Surgical treatment and prognosis for patients with gastric cancer lesions larger than ten centimeters in size. Oncology. 1995; 52(1):35-40. DOI: 10.1159/000227424. View

17.

Leake P, Cardoso R, Seevaratnam R, Lourenco L, Helyer L, Mahar A . A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer. Gastric Cancer. 2011; 15 Suppl 1:S38-47. DOI: 10.1007/s10120-011-0047-z. View

18.

Smyth E, Schoder H, Strong V, Capanu M, Kelsen D, Coit D . A prospective evaluation of the utility of 2-deoxy-2-[(18) F]fluoro-D-glucose positron emission tomography and computed tomography in staging locally advanced gastric cancer. Cancer. 2012; 118(22):5481-8. DOI: 10.1002/cncr.27550. View

19.

Shimada H, Noie T, Ohashi M, Oba K, Takahashi Y . Clinical significance of serum tumor markers for gastric cancer: a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association. Gastric Cancer. 2013; 17(1):26-33. DOI: 10.1007/s10120-013-0259-5. View

20.

Iwasaki Y, Sasako M, Yamamoto S, Nakamura K, Sano T, Katai H . Phase II study of preoperative chemotherapy with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). J Surg Oncol. 2013; 107(7):741-5. DOI: 10.1002/jso.23301. View