The Role of Staging Laparoscopy in Stage IV Gastric Cancer Patients.

IF 1.2 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Digestive Surgery Pub Date : 2025-01-01 Epub Date: 2025-03-07 DOI:10.1159/000543489
Leonardo Solaini, Federica Filippini, Daniele Marrelli, Marco Milone, Luigina Graziosi, Marco Realis Luc, Monica Gualtierotti, Silvia Sofia, Fausto Rosa, Maria Bencivenga, Sergio Alfieri, Giovanni Ferrari, Rossella Reddavid, Stefano De Pascale, Annibale Donini, Giovanni De Palma, Franco Roviello, Paolo Morgagni, Giorgio Ercolani
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引用次数: 0

Abstract

Introduction: Evidence regarding staging laparoscopy (SL) for clinical metastatic (cM+) gastric cancer (GC) patients is limited. Recently, an Italian Gastric Cancer Research Group (GIRCG) study showed SL changed peritoneal status in over 20% of cases. This study aimed to evaluate SL's role in cM+ patients and refine its indications.

Methods: Clinical data of cM+ GC patients who underwent SL between 2010 and 2022 at nine GIRCG centers were retrospectively analyzed. The primary outcome was SL's yield, defined as peritoneal status changed by SL over all SLs.

Results: Among 182 cM+ patients who received SL, 38 (20.9%) had SL-findings changing peritoneal status. Notably, 10.1% of cases with preoperative signs of carcinomatosis had no peritoneal disease, while 46.3% with extraperitoneal disease alone had peritoneal carcinomatosis (PC) at SL. Thirty-one patients (17.0%) underwent R0 resection: 17 (54.8%) with PC, 3 (9.7%) with liver metastases, 4 (12.9%) with PC and nodal metastases, 2 (6.4%) with lung, and 1 (3.2%) with bone metastases. Seventeen patients with suspected preoperative PC underwent curative treatment: 9 had peritoneal disease ruled out by SL, while the other 8 had limited PC, allowing R0 resection. Logistic regression revealed an inverse correlation between diffuse histotype and absence of PC at SL in patients with peritoneal involvement at imaging (p = 0.02).

Conclusion: SL aids in directing cM+ GC patients to appropriate treatment, with a 20.9% yield. For those with peritoneal involvement at imaging, SL helps identify candidates for curative treatment. In patients with extraperitoneal disease, SL should be considered to assess potential radical strategies.

分期腹腔镜在IV期胃癌患者中的作用。
关于临床转移性胃癌(GC)患者腹腔镜(SL)分期的证据有限。最近,意大利胃癌研究小组(GIRCG)的研究表明,SL改变了超过20%的腹膜状态。本研究旨在评估SL在cM+患者中的作用并完善适应症。方法:回顾性分析2010年至2022年9个GIRCG中心cM+ GC患者行SL的资料。主要终点是所有SLs的SL产率,定义为由SL改变的腹膜状态。结果:182例接受SL治疗的cM+患者中,38例(20.9%)有SL表现改变腹膜状态,10.1%术前有腹膜癌(PC)症状的患者无腹膜病变,46.3%单纯腹膜外病变患者有腹膜癌(PC), 31例(17.0%)行R0切除术,其中PC 17例(54.8%),肝转移3例(9.7%),PC合并淋巴结转移4例(12.9%),肺转移2例(6.4%),骨转移1例(3.2%)。17例术前疑似PC患者行根治性治疗,其中9例经SL排除腹膜病变,8例PC受限,允许R0切除。Logistic回归分析显示,影像学累及腹膜患者的弥漫性组织型与SL处PC缺失呈负相关(p=0.02)。结论:SL有助于指导cM+ GC患者接受适当的治疗,成功率为20.9%。对于那些在影像学上有腹膜受累的患者,SL有助于确定治疗的候选者。对于腹腔外疾病患者,应考虑SL来评估潜在的根治性策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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