Predictive factors for the detection of occult metastases during staging laparoscopy in patients with gastric carcinoma and adenocarcinoma of the esophagogastric junction.

Abstract

Introduction: Peritoneal metastasis can occur in all stages of gastric cancer (GC) and adenocarcinoma of the esophagogastric junction (AEG) but staging laparoscopy (SL) is recommended for advanced stages. This study aimed to evaluate predictive factors for the detection of further, previously unknown (occult) metastases during SL.

Materials & methods: We conducted a retrospective analysis of patients who underwent SL at our center between 2005 and 2018. Binary logistic regression analysis was used to identify risk factors for the occurrence of occult metastasis.

Results: A total of 232 patients were included in the analysis. Occult metastases were detected in 48 (20.7%) patients. Forty patients (17.2%) had peritoneal carcinomatosis, 4 (1.6%) had liver metastases, 3 (1.2%) had peritoneal and liver metastases, and 1 (0.4%) had omental metastases. Univariate analysis revealed that cT4 category; cM-positivity; WHO G3 grade; histology results revealing diffuse, mixed or undifferentiated Lauren subtypes; and signet ring cells were significant risk factors for occult metastasis. Multivariate analysis confirmed that cM-positive stage (OR: 17.672; 95% CI: 3.06 to 102.052; p = 0.001) and signet ring cell count (OR: 6.228; 95% CI: 1.151 to 33.716; p = 0.034) were independently associated with occult metastasis detection by SL.

Conclusion: Occult metastases are common in patients with GC or AEG who undergo SL. Histological evidence of signet ring cells should be considered a high-risk histology result and should be an independent indication for SL. Patients with positive cM staging might benefit from SL because of the high probability of further occult metastases.