Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma.
Adenocarcinoma
/ diagnosis
Aged
Female
Follow-Up Studies
Gastrectomy
/ methods
Gastric Mucosa
/ pathology
Humans
Incidence
Kaplan-Meier Estimate
Laparoscopy
/ methods
Male
Middle Aged
Neoplasm Staging
Peritoneal Neoplasms
/ diagnosis
Peritoneum
/ pathology
Prospective Studies
Retrospective Studies
Stomach Neoplasms
/ diagnosis
Treatment Outcome
Cancer
Carcinomatosis
Peritoneal staging
Stomach
Survival
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
17 Feb 2020
17 Feb 2020
Historique:
received:
11
11
2019
accepted:
06
02
2020
entrez:
19
2
2020
pubmed:
19
2
2020
medline:
25
11
2020
Statut:
epublish
Résumé
Staging laparoscopy and peritoneal cytology can detect occult metastatic disease prior to treatment of gastric cancer. The yield of peritoneal staging in patients with early stage disease is lacking. We assess the yield of peritoneal staging in early stage gastric cancer and its impact on survival. Data were obtained from a prospective database of patients who underwent staging laparoscopy and peritoneal cytology for gastric cancer at our institution between July 1995 and July 2018. Clinical stage was determined by endoscopic ultrasound, and early stage was defined as cT1-2 and cN0. Rates of positive cytology and carcinomatosis at time of laparoscopy were obtained. Univariate analyses were used to compare groups, and Kaplan-Meier survival analyses were used to assess survival outcomes. Eight hundred sixty-seven patients underwent staging laparoscopy and peritoneal cytology; 56 were defined as early stage. Age was 61 ± 12 years, 66.4% were male, and 62.3% were white. Of the patients with early stage disease, 17.9% had either gross carcinomatosis (10.7%) and/or positive peritoneal cytology (10.9%). All cases of peritoneal disease were in patients with cT2 disease. There were no differences in age, gender, or race based on peritoneal disease (all p > 0.05). The presence of carcinomatosis or positive cytology significantly affected overall survival (p < 0.001), regardless of clinical T or N stage. Peritoneal staging identifies metastatic disease in a significant number of patients with early stage disease. Given its poor prognosis and alternate therapy options, independent staging laparoscopy and peritoneal cytology should be considered in patients with early stage gastric adenocarcinoma.
Sections du résumé
BACKGROUND
BACKGROUND
Staging laparoscopy and peritoneal cytology can detect occult metastatic disease prior to treatment of gastric cancer. The yield of peritoneal staging in patients with early stage disease is lacking. We assess the yield of peritoneal staging in early stage gastric cancer and its impact on survival.
METHODS
METHODS
Data were obtained from a prospective database of patients who underwent staging laparoscopy and peritoneal cytology for gastric cancer at our institution between July 1995 and July 2018. Clinical stage was determined by endoscopic ultrasound, and early stage was defined as cT1-2 and cN0. Rates of positive cytology and carcinomatosis at time of laparoscopy were obtained. Univariate analyses were used to compare groups, and Kaplan-Meier survival analyses were used to assess survival outcomes.
RESULTS
RESULTS
Eight hundred sixty-seven patients underwent staging laparoscopy and peritoneal cytology; 56 were defined as early stage. Age was 61 ± 12 years, 66.4% were male, and 62.3% were white. Of the patients with early stage disease, 17.9% had either gross carcinomatosis (10.7%) and/or positive peritoneal cytology (10.9%). All cases of peritoneal disease were in patients with cT2 disease. There were no differences in age, gender, or race based on peritoneal disease (all p > 0.05). The presence of carcinomatosis or positive cytology significantly affected overall survival (p < 0.001), regardless of clinical T or N stage.
CONCLUSIONS
CONCLUSIONS
Peritoneal staging identifies metastatic disease in a significant number of patients with early stage disease. Given its poor prognosis and alternate therapy options, independent staging laparoscopy and peritoneal cytology should be considered in patients with early stage gastric adenocarcinoma.
Identifiants
pubmed: 32066454
doi: 10.1186/s12957-020-01813-y
pii: 10.1186/s12957-020-01813-y
pmc: PMC7026970
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
39Subventions
Organisme : NCI NIH HHS
ID : T32 CA009599
Pays : United States
Organisme : NIH HHS
ID : T32 CA 009599
Pays : United States
Organisme : NCI NIH HHS
ID : P30CA016672
Pays : United States
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