Annals of Surgical Oncology

, Volume 20, Issue 2, pp 548–554

Role of Repeat Staging Laparoscopy in Locoregionally Advanced Gastric or Gastroesophageal Cancer after Neoadjuvant Therapy

  • Kenneth Cardona
  • Qin Zhou
  • Mithat Gönen
  • Manish A. Shah
  • Vivian E. Strong
  • Murray F. Brennan
  • Daniel G. Coit
Gastrointestinal Oncology

DOI: 10.1245/s10434-012-2598-6

Cite this article as:
Cardona, K., Zhou, Q., Gönen, M. et al. Ann Surg Oncol (2013) 20: 548. doi:10.1245/s10434-012-2598-6

Abstract

Introduction

Staging laparoscopy (SL) can identify occult, subradiographic metastatic (M1) disease in patients with gastric or gastroesophageal (G/GEJ) cancer who are unlikely to benefit from gastrectomy. The purpose of this study is to determine the yield of repeat SL following neoadjuvant therapy for G/GEJ adenocarcinoma after initial negative pretreatment SL.

Methods

Retrospective review of a prospective database identified patients with locoregionally advanced (T3–4Nany or TanyN+) G/GEJ adenocarcinoma who underwent pretreatment SL. The yield of repeat SL following neoadjuvant therapy was determined.

Results

From 1994 to 2010, 276 patients with locoregionally advanced G/GEJ adenocarcinoma were identified, of whom 244 proceeded to operation after neoadjuvant therapy, at a median time of 105 days. One hundred sixty-four patients (67 %) underwent repeat SL, and 80 patients (33 %) proceeded directly to laparotomy. Occult M1 disease was identified in 12 (7.3 %) and 6 (7.5 %) patients, respectively. In the repeat SL cohort, M1 disease was identified at laparoscopy in nine patients (5.5 %). M1 disease not identified by laparoscopy was discovered at laparotomy in three patients (1.8 %). The median follow-up for the study population was 31 months. For patients with M1 disease, median overall survival was 15 months, versus 41 months for patients resected without M1 disease (p < 0.0001).

Conclusions

Occult, subradiographic M1 disease develops in approximately 7 % of patients following neoadjuvant therapy for locoregionally advanced G/GEJ adenocarcinoma. These patients have poor prognosis, and repeat SL can be a valuable tool in selecting patients with locoregionally advanced G/GEJ tumors for potentially curative resection after neoadjuvant therapy.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Kenneth Cardona
    • 1
  • Qin Zhou
    • 2
  • Mithat Gönen
    • 2
  • Manish A. Shah
    • 3
  • Vivian E. Strong
    • 1
  • Murray F. Brennan
    • 1
  • Daniel G. Coit
    • 1
  1. 1.Gastric and Mixed Tumor Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Gastrointestinal Oncology Service, Department of MedicineWeill Cornell Medical CollegeNew YorkUSA