TY - JOUR
T1 - Repeat staging laparoscopy for gastric cancer after preoperative therapy
AU - Thiels, Cornelius A.
AU - Ikoma, Naruhiko
AU - Fournier, Keith
AU - Das, Prajnan
AU - Blum, Mariela
AU - Estrella, Jeannelyn S.
AU - Minsky, Bruce D.
AU - Ajani, Jaffer
AU - Mansfield, Paul
AU - Badgwell, Brian D.
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background and Objectives: Staging laparoscopy is recommended before preoperative therapy in patients with locoregional gastric cancer, but yield of repeated diagnostic laparoscopy at the time of resection is unknown. Methods: Retrospective review of a prospective database of patients with gastric adenocarcinoma (1994-2016) who had negative staging laparoscopy followed by preoperative therapy and subsequent attempted resection. Primary outcome was positive exploration (peritoneal or unresectable disease) at the time of resection. Multivariable logistic regression identified factors associated with positive exploration. Results: Of the 451 patients with attempted resection, 54 (12.0%) had positive explorations, including 48 with peritoneal disease. Patients with positive explorations were more likely to be female and have poorly differentiated tumors, linitis features, and signet-ring morphology. There was no significant difference by exploration results in age, race, clinical stage, or delayed definitive surgery. Positive explorations were independently associated with poor differentiation (OR 4.6, 95%CI 1.4-15.3; P = 0.01) and linitis (OR 4.2, 95%CI 1.9-9.2; P < 0.001). Positive explorations were seen in 14.0% of patients with poor differentiation, 36.6% of patients with linitis, and 5.8% of patients with neither linitis nor poor differentiation. Conclusion: Despite negative pretreatment laparoscopy, post-treatment repeat laparoscopy may prevent non-therapeutic laparotomies. At a minimum, we recommend selective repeat laparoscopy for patients with linitis features.
AB - Background and Objectives: Staging laparoscopy is recommended before preoperative therapy in patients with locoregional gastric cancer, but yield of repeated diagnostic laparoscopy at the time of resection is unknown. Methods: Retrospective review of a prospective database of patients with gastric adenocarcinoma (1994-2016) who had negative staging laparoscopy followed by preoperative therapy and subsequent attempted resection. Primary outcome was positive exploration (peritoneal or unresectable disease) at the time of resection. Multivariable logistic regression identified factors associated with positive exploration. Results: Of the 451 patients with attempted resection, 54 (12.0%) had positive explorations, including 48 with peritoneal disease. Patients with positive explorations were more likely to be female and have poorly differentiated tumors, linitis features, and signet-ring morphology. There was no significant difference by exploration results in age, race, clinical stage, or delayed definitive surgery. Positive explorations were independently associated with poor differentiation (OR 4.6, 95%CI 1.4-15.3; P = 0.01) and linitis (OR 4.2, 95%CI 1.9-9.2; P < 0.001). Positive explorations were seen in 14.0% of patients with poor differentiation, 36.6% of patients with linitis, and 5.8% of patients with neither linitis nor poor differentiation. Conclusion: Despite negative pretreatment laparoscopy, post-treatment repeat laparoscopy may prevent non-therapeutic laparotomies. At a minimum, we recommend selective repeat laparoscopy for patients with linitis features.
KW - gastric cancer
KW - laparoscopy
KW - neoadjuvant
KW - preoperative therapy
KW - staging
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U2 - 10.1002/jso.25094
DO - 10.1002/jso.25094
M3 - Article
C2 - 29878364
AN - SCOPUS:85053271128
SN - 0022-4790
VL - 118
SP - 61
EP - 67
JO - Journal of surgical oncology
JF - Journal of surgical oncology
IS - 1
ER -