Skip to main content
SpringerLink
Log in

The Role of Staging Laparoscopy and Peritoneal Cytology in Gastric Cancer

  • Chapter
  • First Online:
Gastric Cancer

  • 2647 Accesses

Abstract

Staging laparoscopy is an important yet underutilized tool in the treatment of patients with gastric adenocarcinoma. The principle goal of staging laparoscopy is to identify patients with operable primary lesions absent of macroscopic or microscopic metastatic disease. Despite appropriate preoperative radiographic staging, approximately a quarter of the patients with seemingly operable disease are in fact found to have occult gross metastatic lesions on staging laparoscopy. Moreover, patients with advanced lesions (serosal invasion, nodal disease) are particularly at a high risk of microscopic metastases into the surrounding peritoneal fluid. Sampling the peritoneal fluid for free tumor cells during laparoscopy identifies patients with microscopic metastatic disease, a diagnosis that portends a similarly poor prognosis to patients with gross metastatic disease. Identifying these patients prior to laparotomy not only saves the patient the morbidity of a needless major surgery but also prevents the delay of further chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ajani A, Bentrem D, Besh S, et al. NCCN clinical practice guidelines in oncology: gastric cancer 2013. Version 2.2013. www.nccn.org .

  2. Karanicolas PJ, Elkin EB, Jacks LM, Atoria CL, Strong VE, Brennan MF, Coit DG. Staging laparoscopy in the management of gastric cancer: a population-based analysis. J Am Coll Surg. 2011;213(5):644–51, 51 e1. doi:10.1016/j.jamcollsurg.2011.07.018. PubMed PMID: 21872497.

    Article  PubMed  Google Scholar 

  3. Burke EC, Karpeh MS, Conlon KC, Brennan MF. Laparoscopy in the management of gastric adenocarcinoma. Ann Surg. 1997;225(3):262–7. PubMed PMID: 9060581; PubMed Central PMCID: PMC1190675.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Kriplani AK, Kapur BM. Laparoscopy for pre-operative staging and assessment of operability in gastric carcinoma. Gastrointest Endosc. 1991;37(4):441–3. PubMed PMID: 1833260.

    Article  CAS  PubMed  Google Scholar 

  5. Lowy AM, Mansfield PF, Leach SD, Ajani J. Laparoscopic staging for gastric cancer. Surgery. 1996;119(6):611–4. PubMed PMID: 8650600.

    Article  CAS  PubMed  Google Scholar 

  6. Stell DA, Carter CR, Stewart I, Anderson JR. Prospective comparison of laparoscopy, ultrasonography and computed tomography in the staging of gastric cancer. Br J Surg. 1996;83(9):1260–2. PubMed PMID: 8983624.

    Article  CAS  PubMed  Google Scholar 

  7. Asencio F, Aguilo J, Salvador JL, Villar A, De la Morena E, Ahamad M, Escrig J, Puche J, Viciano V, Sanmiguel G, Ruiz J. Video-laparoscopic staging of gastric cancer. A prospective multicenter comparison with noninvasive techniques. Surg Endosc. 1997;11(12):1153–8. PubMed PMID: 9373284.

    Article  CAS  PubMed  Google Scholar 

  8. D’Ugo DM, Persiani R, Caracciolo F, Ronconi P, Coco C, Picciocchi A. Selection of locally advanced gastric carcinoma by preoperative staging laparoscopy. Surg Endosc. 1997;11(12):1159–62. PubMed PMID: 9373285.

    Article  PubMed  Google Scholar 

  9. Romijn MG, van Overhagen H, Spillenaar Bilgen EJ, Ijzermans JN, Tilanus HW, Lameris JS. Laparoscopy and laparoscopic ultrasonography in staging of oesophageal and cardial carcinoma. Br J Surg. 1998;85(7):1010–2. doi:10.1046/j.1365–2168.1998.00742.x. PubMed PMID: 9692586.

    Article  CAS  PubMed  Google Scholar 

  10. Yano M, Tsujinaka T, Shiozaki H, Inoue M, Sekimoto M, Doki Y, Takiguchi S, Imamura H, Taniguchi M, Monden M. Appraisal of treatment strategy by staging laparoscopy for locally advanced gastric cancer. World J Surg. 2000;24(9):1130–5; discussion 5–6. PubMed PMID: 11036293.

    Article  CAS  PubMed  Google Scholar 

  11. Leake PA, Cardoso R, Seevaratnam R, Lourenco L, Helyer L, Mahar A, Law C, Coburn NG. A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer. Gastric Cancer. 2012;15(Suppl 1):S38–47. doi:10.1007/s10120-011-0047-z. PubMed PMID: 21667136.

    Article  PubMed  Google Scholar 

  12. Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg. 2006;191(1):134–8. doi:10.1016/j.amjsurg.2005.10.015. PubMed PMID: 16399124.

    Article  PubMed  Google Scholar 

  13. Power DG, Schattner MA, Gerdes H, Brenner B, Markowitz AJ, Capanu M, Coit DG, Brennan M, Kelsen DP, Shah MA. Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer. J Am Coll Surg. 2009;208(2):173–8. doi:10.1016/j.jamcollsurg.2008.10.022. PubMed PMID: 19228527.

    Article  PubMed  Google Scholar 

  14. Bartlett EK, Roses RE, Kelz RR, Drebin JA, Fraker DL, Karakousis GC. Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery. 2014;156(2):298–304. doi:10.1016/j.surg.2014.03.022. PubMed PMID: 24947651.

    Article  PubMed  Google Scholar 

  15. Sarela AI, Miner TJ, Karpeh MS, Coit DG, Jaques DP, Brennan MF. Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma. Ann Surg. 2006;243(2):189–95. doi:10.1097/01.sla.0000197382.43208.a5. PubMed PMID: 16432351; PubMed Central PMCID: PMC1448917.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kelly KJ, Wong J, Gladdy R, Moore-Dalal K, Woo Y, Gonen M, Brennan M, Allen P, Fong Y, Coit D. Prognostic impact of RT-PCR-based detection of peritoneal micrometastases in patients with pancreatic cancer undergoing curative resection. Ann Surg Oncol. 2009;16(12):3333–9. doi:10.1245/s10434-009-0683-2. PubMed PMID: 19763694; PubMed Central PMCID: PMC3275341.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Fujiwara Y, Okada K, Hanada H, Tamura S, Kimura Y, Fujita J, Imamura H, Kishi K, Yano M, Miki H, Okada K, Takayama O, Aoki T, Mori M, Doki Y. The clinical importance of a transcription reverse-transcription concerted (TRC) diagnosis using peritoneal lavage fluids in gastric cancer with clinical serosal invasion: a prospective, multicenter study. Surgery. 2014;155(3):417–23. doi:10.1016/j.surg.2013.10.004. PubMed PMID: 24439740.

    Article  PubMed  Google Scholar 

  18. Munasinghe A, Kazi W, Taniere P, Hallissey MT, Alderson D, Tucker O. The incremental benefit of two quadrant lavage for peritoneal cytology at staging laparoscopy for oesophagogastric adenocarcinoma. Surg Endosc. 2013;27(11):4049–53. doi:10.1007/s00464-013-3058-5. PubMed PMID: 23836122.

    Article  PubMed  Google Scholar 

  19. Bonenkamp JJ, Songun I, Hermans J, van de Velde CJ. Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer. Br J Surg. 1996;83(5):672–4. PubMed PMID: 8689216.

    Article  CAS  PubMed  Google Scholar 

  20. Bando E, Yonemura Y, Takeshita Y, Taniguchi K, Yasui T, Yoshimitsu Y, Fushida S, Fujimura T, Nishimura G, Miwa K. Intraoperative lavage for cytological examination in 1297 patients with gastric carcinoma. Am J Surg. 1999;178(3):256–62. PubMed PMID: 10527450.

    Article  CAS  PubMed  Google Scholar 

  21. Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, Morimoto T, Kato T. Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection. J Surg Oncol. 1999;72(2):60–4; discussion 4–5. PubMed PMID: 10518099.

    Article  CAS  PubMed  Google Scholar 

  22. Bentrem D, Wilton A, Mazumdar M, Brennan M, Coit D. The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection. Ann Surg Oncol. 2005;12(5):347–53. doi:10.1245/ASO.2005.03.065. PubMed PMID: 15915368.

    Article  PubMed  Google Scholar 

  23. Ribeiro U Jr, Safatle-Ribeiro AV, Zilberstein B, Mucerino D, Yagi OK, Bresciani CC, Jacob CE, Iryia K, Gama-Rodrigues J. Does the intraoperative peritoneal lavage cytology add prognostic information in patients with potentially curative gastric resection? J Gastrointest Surg. 2006;10(2):170–6, discussion 6–7. doi:10.1016/j.gassur.2005.11.001. PubMed PMID: 16455447.

    Article  PubMed  Google Scholar 

  24. Edge S, Cancer AJCo. AJCC cancer staging manual. New York: Springer; 2010.

    Google Scholar 

  25. Badgwell B, Cormier JN, Krishnan S, Yao J, Staerkel GA, Lupo PJ, Pisters PW, Feig B, Mansfield P. Does neoadjuvant treatment for gastric cancer patients with positive peritoneal cytology at staging laparoscopy improve survival? Ann Surg Oncol. 2008;15(10):2684–91. doi:10.1245/s10434-008-0055-3. PubMed PMID: 18649106.

    Article  PubMed  Google Scholar 

  26. Lorenzen S, Panzram B, Rosenberg R, Nekarda H, Becker K, Schenk U, Hofler H, Siewert JR, Jager D, Ott K. Prognostic significance of free peritoneal tumor cells in the peritoneal cavity before and after neoadjuvant chemotherapy in patients with gastric carcinoma undergoing potentially curative resection. Ann Surg Oncol. 2010;17(10):2733–9. doi:10.1245/s10434-010-1090-4. PubMed PMID: 20490698.

    Article  PubMed  Google Scholar 

  27. Mezhir JJ, Shah MA, Jacks LM, Brennan MF, Coit DG, Strong VE. Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Ann Surg Oncol. 2010;17(12):3173–80. doi:10.1245/s10434-010-1183-0. PubMed PMID: 20585870.

    Article  PubMed  Google Scholar 

  28. De Andrade JP, Mezhir JJ. The critical role of peritoneal cytology in the staging of gastric cancer: an evidence-based review. J Surg Oncol. 2014;110(3):291–7. doi:10.1002/jso.23632. PubMed PMID: 24850538.

    Article  PubMed  Google Scholar 

  29. Cabalag CS, Chan ST, Kaneko Y, Duong CP. A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology. Gastric Cancer. 2014. doi:10.1007/s10120-014-0388-5. PubMed PMID: 24890254.

    Google Scholar 

  30. Kuramoto M, Shimada S, Ikeshima S, Matsuo A, Yagi Y, Matsuda M, Yonemura Y, Baba H. Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma. Ann Surg. 2009;250(2):242–6. doi:10.1097/SLA.0b013e3181b0c80e. PubMed PMID: 19638909.

    Article  PubMed  Google Scholar 

  31. Okabe H, Ueda S, Obama K, Hosogi H, Sakai Y. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol. 2009;16(12):3227–36. doi:10.1245/s10434-009-0706-z. PubMed PMID: 19777180.

    Article  PubMed  Google Scholar 

  32. Mezhir JJ, Shah MA, Jacks LM, Brennan MF, Coit DG, Strong VE. Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Indian J Surg Oncol. 2011;2(1):16–23. doi:10.1007/s13193-011-0074-6. PubMed PMID: 22696066; PubMed Central PMCID: PMC3373003.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Iowa Health Care, Iowa City, IA, USA

    James P. De Andrade MD & James J. Mezhir MD

  2. Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H-1217, 10065, New York, NY, USA

    Vivian E. Strong MD

Authors
  1. James P. De Andrade MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James J. Mezhir MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vivian E. Strong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vivian E. Strong MD .

Editor information

Editors and Affiliations

  1. Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Vivian E. Strong

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

De Andrade, J., Mezhir, J., Strong, V. (2015). The Role of Staging Laparoscopy and Peritoneal Cytology in Gastric Cancer. In: Strong, V. (eds) Gastric Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-15826-6_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15826-6_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15825-9

  • Online ISBN: 978-3-319-15826-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation