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Staging laparoscopy for advanced gastric cancer: significance of preoperative clinicopathological factors

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Abstract

Purpose

Although the use of staging laparoscopy (SL) for detecting peritoneal metastasis (P) and determining peritoneal lavage cytology (CY) is widespread in advanced gastric cancer, an indication for SL based on preoperative clinicopathological factors is controversial.

Methods

From May 2006 to September 2015, 120 patients with advanced gastric cancer with primary tumors ≥5 cm and/or with bulky regional lymph nodes (bulky N) underwent SL for assessment of P/CY status. Clinicopathological factors were analyzed retrospectively to determine their influence on peritoneal spread (P1 and/or CY1). An additional analysis of 379 consecutive patients with clinically T2 or deeper gastric cancer in the same time period was carried out to confirm the SL results.

Results

Peritoneal spread was confirmed by SL in 54 cases (45%). The presence of type-4 tumors (n = 38, p < 0.0001) and diffuse-type tumors (n = 85, p = 0.04) correlated significantly with peritoneal spread. These two factors were also correlated significantly with increased peritoneal spread in a subgroup analysis among patients with tumors with bulky N (n = 44). The additional analysis of 379 patients showed results consistent with the SL results. The frequency of peritoneal spread was 78% among type-4 tumors, 47% among diffuse-type tumors ≥5 cm, and 38% among diffuse-type tumors with bulky N, whereas among intestinal-type tumors, it was 18% in tumors ≥5 cm and 13% among tumors with bulky N.

Conclusions

Among tumors ≥5 cm or with bulky N, type-4 tumors and diffuse-type tumors had a high potential for peritoneal spread and patients with such tumors were considered more suitable candidates for SL.

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Author’s contributions

Study conception and design: Hosogi H and Okabe H; acquisition of data: Hosogi H and Sumida H; analysis and interpretation of data: Tsunoda S, Hisamori S, Hida K, and Obama K; drafting of manuscript: Hosogi H; critical revision of manuscript: Shinohara H, Tsunoda S, Okabe H, and Sakai Y.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Hisahiro Hosogi, Hisashi Shinohara, Shigeru Tsunoda, Shigeo Hisamori, Hitoshi Sumida, Koya Hida, Kazutaka Obama, Hiroshi Okabe & Yoshiharu Sakai

  2. Department of Surgery, Kyoto City Hospital, Kyoto, Japan

    Kazutaka Obama

  3. Department of Surgery, Otsu Municipal Hospital, Otsu, Japan

    Hiroshi Okabe

Authors
  1. Hisahiro Hosogi
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  2. Hisashi Shinohara
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  3. Shigeru Tsunoda
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  4. Shigeo Hisamori
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  5. Hitoshi Sumida
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  6. Koya Hida
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  7. Kazutaka Obama
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  8. Hiroshi Okabe
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  9. Yoshiharu Sakai
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Corresponding author

Correspondence to Hisahiro Hosogi.

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No funding was received for research or publication.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hosogi, H., Shinohara, H., Tsunoda, S. et al. Staging laparoscopy for advanced gastric cancer: significance of preoperative clinicopathological factors. Langenbecks Arch Surg 402, 33–39 (2017). https://doi.org/10.1007/s00423-016-1536-7

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  • DOI: https://doi.org/10.1007/s00423-016-1536-7

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