Staging laparoscopy in patients with gastric cancer can improve treatment decision-making and help avoid potentially unnecessary laparotomy, according to a new study.
Early gastric cancer often presents with no symptoms or with symptoms such as heartburn or nausea that can be easily confused with other conditions. Therefore, many cases of gastric cancer are not identified until a more advanced stage. The standard treatment for advanced gastric cancer is a combination of surgery and systemic chemotherapy based on a clinical evaluation of the disease stage by imaging and exploratory laparotomy, an invasive open-abdomen procedure. Proper use of these methods are vital for deciding on a treatment approach: underestimating tumor stage by imaging may lead to unnecessary laparotomy, and over estimation may exclude surgery as a potentially potent treatment option.
A study published in the World Journal of Gastroenterology aimed to evaluate whether staging laparoscopy could be used after imaging as an effective means of avoiding unnecessary laparotomy.
Researchers identified 582 eligible patients with gastric cancer, all of whom had undergone preoperative staging via imaging. After staging laparoscopy was performed, treatment plans for a total of 211 (36.3%) patients were changed due to a change in staging.
With staging by imaging, a total of 19 patients were thought to have metastases and were scheduled to receive palliative surgery. The other 563 patients had cancer that was still localized and were eligible for different radical surgery procedures. After laparoscopic staging, two of the 19 patients (10.5%) thought to have metastatic cancer were restaged and given the opportunity to receive radical surgery. Unnecessary laparotomy was also avoided in 71 patients (12.2%). Laparoscopy was also found to provide strong agreement between preoperative and final staging compared with imaging methods, which were in fair agreement.
From the results, Yan-Feng Hu (Dongguan People’s Hospital, Guangdong Province, China) and coauthors concluded that laparoscopy was a valuable clinical tool for enhancing decision-making for patients with advanced gastric cancer.
