The Impact of Diagnostic Laparoscopy on Upstaging Patients with Siewert II and III Gastroesophageal Junction (GEJ) Cancer.

IF 3.4 2区 医学 Q2 ONCOLOGY
Annals of Surgical Oncology Pub Date : 2025-01-01 Epub Date: 2024-11-06 DOI:10.1245/s10434-024-15862-0
Nathan J Alcasid, Deanna Fink, Kian C Banks, Cynthia J Susai, Katherine Barnes, Rachel Wile, Angela Sun, Ashish Patel, Simon Ashiku, Jeffrey B Velotta
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Abstract

Background: The efficacy of routine diagnostic laparoscopy with cytologic evaluation for gastroesophageal junction (GEJ) cancer is variable with no set guidelines. We hypothesize that findings from diagnostic laparoscopy in Siewert II and III GEJ tumors may differ, where routine diagnostic laparoscopy with washings yields low upstaging results in Siewert II compared with Siewert III tumors.

Patients and methods: We reviewed patients with Siewert II/III GEJ cancer from 2012 through 2022 within our integrated health system. Chi-squared, Fisher's exact, and two-sample Wilcoxon rank-sum tests were utilized. The outcomes measured include likelihood of upstaging, cytology positivity, times to chemotherapy and surgery, and 5-year mortality using a multivariable Cox regression model.

Results: Of 265 patients with Siewert II diagnosis, 116 patients underwent a diagnostic laparoscopy while 149 patients did not. Median time to chemotherapy initiation and definitive surgery were increased among patients with diagnostic laparoscopy, with no difference observed in 5-year survival. For patients with Siewert II and III with a diagnostic laparoscopy, 5% of Siewert II were upstaged, compared with 17% of Siewert III (p = 0.025). Obtaining cytologic washings alone were less likely to be upstaged compared with receiving a biopsy with or without washings (5.2% vs. 17.3%, p = 0.039), and those with Siewert II were less likely than Siewert III to be upstaged after diagnostic laparoscopy (5.2% vs. 17.4%, p = 0.025).

Conclusions: Routine diagnostic laparoscopy yields a low upstaging rate in Siewert II GEJ adenocarcinomas (AC) while delaying treatment with no improvement on mortality. Expediting definitive surgery with selective biopsy in lieu of diagnostic laparoscopy may improve oncologic outcomes.

诊断性腹腔镜检查对Siewert II和III型胃食管结合部(GEJ)癌症患者分期的影响
背景:对胃食管交界处(GEJ)癌症进行常规诊断性腹腔镜检查和细胞学评估的效果各不相同,也没有固定的指导方针。我们假设诊断性腹腔镜检查对Siewert II和III型胃食管连接部肿瘤的结果可能不同,其中常规诊断性腹腔镜检查与洗片对Siewert II型胃食管连接部肿瘤的分期结果低于Siewert III型胃食管连接部肿瘤:我们回顾了 2012 年至 2022 年在我们的综合医疗系统中患 Siewert II/III 型胃食管癌的患者。采用了卡方检验、费雪精确检验和双样本 Wilcoxon 秩和检验。采用多变量考克斯回归模型测量的结果包括上行分期的可能性、细胞学阳性率、化疗和手术时间以及5年死亡率:在确诊为Siewert II的265名患者中,116名患者接受了腹腔镜诊断,149名患者没有接受腹腔镜诊断。接受诊断性腹腔镜检查的患者接受化疗和最终手术的中位时间延长,但5年生存率没有差异。在接受诊断性腹腔镜检查的Siewert II和III期患者中,5%的Siewert II期患者进行了分期,而Siewert III期患者的分期率为17%(P = 0.025)。与接受有或无细胞清洗的活组织检查相比,仅接受细胞清洗的患者病情恶化的几率较低(5.2% vs. 17.3%,p = 0.039),Siewert II患者在接受诊断性腹腔镜检查后病情恶化的几率低于Siewert III患者(5.2% vs. 17.4%,p = 0.025):结论:常规诊断性腹腔镜检查对Siewert II型胃食管腺癌(AC)的上行分期率较低,但会延误治疗,对死亡率没有改善。用选择性活检代替诊断性腹腔镜检查,加快明确手术可能会改善肿瘤治疗效果。
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来源期刊
CiteScore
5.90
自引率
10.80%
发文量
1698
审稿时长
2.8 months
期刊介绍: The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
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