Staging laparoscopy in gastroesophageal and gastric adenocarcinoma: First experience from Pakistan.
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Date
2014-01
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Abstract
CONTEXT: Current NCCN guidelines do not consider staging laparoscopy mandatory for detection of metastasis in gastroesophageal junction (GEJ)
and gastric cancer. AIMS: To determine the rate of detection of metastasis on staging laparoscopy in GEJ and gastric cancer in Pakistani population
and determine the prognostic significance of cytology versus biopsy positive metastatic disease. SETTINGS AND DESIGN: Retrospective study
conducted from January 2005 to June 2013. MATERIALS AND METHODS: Demographics, clinicopathological characteristics and laparoscopic
findings of 149 patients were compared. STATISTICAL ANALYSIS USED: Categorical variables were represented as frequencies and percentages
and significance was determined using Chi square test. Overall survival was calculated from the date of staging laparoscopy to the date of death/
last follow‑up. Survival for cytology versus biopsy positive metastatic disease was calculated using Kaplan Meier curves and significance determined
with Log rank test. RESULTS: Overall, metastases were detected in 40% of patients on staging. Laparoscopy detected metastasis in significantly
high number of gastric cancers (48% versus 28%) (P = 0.01). Peritoneal nodules were more frequent with gastric tumors (40% versus 23%) and
also were more likely to be malignant (58% versus 35%). Expected one year survival in patients with positive cytology (peritoneal washing/ascitic
fluid) was significantly higher than patients with a positive peritoneal nodule biopsy (29% versus 0) (P = 0.04). On univariate analysis this was
the only significant factor for increased risk of death (P = 0.03, HR = 2.5, CI = 1.04‑5.98). CONCLUSIONS: Staging laparoscopy detects metastatic
disease in a significant number of patients deemed non metastatic on preoperative imaging. Prognostically, cytology positive metastatic cancer
may be different from biopsy positive cancer.
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Gastric cancer, gastroesophageal cancer, laparoscopy, staging
Citation
Bhatti A B, Haider S, Khattak S, Syed A A. Staging laparoscopy in gastroesophageal and gastric adenocarcinoma: First experience from Pakistan. Indian Journal of Cancer. 2014 Jan-Mar; 51(1): 15-17..