Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2016; 22(5): 1859-1868
Published online Feb 7, 2016. doi: 10.3748/wjg.v22.i5.1859
Staging laparoscopy improves treatment decision-making for advanced gastric cancer
Yan-Feng Hu, Zhen-Wei Deng, Hao Liu, Ting-Yu Mou, Tao Chen, Xin Lu, Da Wang, Jiang Yu, Guo-Xin Li
Yan-Feng Hu, Hao Liu, Ting-Yu Mou, Tao Chen, Xin Lu, Da Wang, Jiang Yu, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Zhen-Wei Deng, Department of General Surgery, Dongguan People’s Hospital, Dongguan 523000, Guangdong Province, China
Author contributions: Hu YF and Deng ZW contributed equally to this work in the design of the study and preparation of the manuscript and should be both considered as co-first authors; Yu J and Li GX contributed equally to this paper; all authors approved the final manuscript.
Supported by Guangdong Provincial Science and Technology Key Project, the National Key Technology R and D Program, No. 2013BAI05B00; the Major Program of Science and Technology Program of Guangzhou, No. 201300000087; research Fund of Public Welfare in Health Industry, Health Ministry of China, No. 201402015; Research Fund of Public Welfare in Health Industry, No. 201502039; and Key Clinical Specialty Discipline Construction Program.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Nanfang Hospital.
Informed consent statement: Patients were given informed consent and agreed to participate in the study.
Conflict-of-interest statement: The authors declare no conflict of interest in this work.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Xin Li, MD, PhD, FRCS, Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. gzliguoxin@163.com
Telephone: +86-20-61641681 Fax: +86-20-61641683
Received: May 5, 2015
Peer-review started: May 11, 2015
First decision: September 29, 2015
Revised: October 19, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: February 7, 2016
Abstract

AIM: To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC).

METHODS: Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ2 test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics.

RESULTS: Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P < 0.05) for staging laparoscopy; compared with CT and EUS, which was in fair agreement. The strength of agreement between preoperative M stage and final M stage was in almost perfect agreement (Kw = 0.990; 95% CI: 0.977-1.000; P < 0.05) for staging laparoscopy; compared with CT, which was in slight agreement. Multivariate analysis revealed that tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed.

CONCLUSION: Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy.

Keywords: Staging laparoscopy, Advanced gastric cancer, Tumor staging, Peritoneal metastasis, Risk factor

Core tip: Staging laparoscopy plays an important role in advanced gastric cancer (GC) staging, which performs better than computed tomography or endoscopic ultrasound. Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy. Tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed.