Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Am Coll Surg. 2011 Nov;213(5):644-651, 651.e1. doi: 10.1016/j.jamcollsurg.2011.07.018. Epub 2011 Aug 26.
Staging laparoscopy can detect radiographically occult peritoneal metastases and prevent futile laparotomy in patients with gastric adenocarcinoma. We sought to assess the use of staging laparoscopy for gastric adenocarcinoma in a cohort of older patients and to compare outcomes after laparoscopy alone with nontherapeutic laparotomy.
Using Surveillance, Epidemiology and End Results (SEER) population-based cancer registry data linked with Medicare claims, we identified patients aged 65 or older diagnosed with gastric adenocarcinoma between 1998 and 2005. We defined staging laparoscopy as a laparoscopic procedure from 1 month before the date of diagnosis until death and futile laparotomy as a laparotomy in the absence of a therapeutic intervention. We examined trends in the use of staging laparoscopy and compared outcomes between patients who underwent staging laparoscopy alone and those who had a futile laparotomy.
Of 11,759 patients with gastric adenocarcinoma, 6,388 (54.3%) had at least 1 surgical procedure. Staging laparoscopy was performed in 506 (7.9%) patients who had any surgery, and 151 (29.8%) of these patients did not have a subsequent therapeutic intervention. Patients who underwent staging laparoscopy alone had a significantly lower rate of in-hospital mortality (5.3% vs 13.1%, p < 0.001) and shorter length of hospitalization (2 vs 10 days, p < 0.001) than patients who had futile laparotomy.
Our findings in this large, population-based cohort suggest that staging laparoscopy is used infrequently in the management of older patients with gastric adenocarcinoma. Increased use of staging laparoscopy could reduce the substantial morbidity and mortality associated with nontherapeutic laparotomy.
腹腔镜分期检查可检测出影像学上隐匿性的腹膜转移灶，避免胃腺癌患者进行无效剖腹手术。我们试图评估腹腔镜分期检查在老年患者胃腺癌病例中的应用，并比较单独行腹腔镜检查与非治疗性剖腹手术的结果。
我们使用监测、流行病学和最终结果（SEER）人群癌症登记数据库，结合医疗保险索赔数据，确定了 1998 年至 2005 年间诊断为胃腺癌且年龄在 65 岁或以上的患者。我们将腹腔镜分期检查定义为从诊断前 1 个月至死亡的腹腔镜检查，将非治疗性剖腹手术定义为未进行治疗性干预的剖腹手术。我们分析了腹腔镜分期检查的使用趋势，并比较了仅行腹腔镜分期检查和行非治疗性剖腹手术的患者的结局。
在 11759 例胃腺癌患者中，有 6388 例（54.3%）至少进行了 1 次手术。在接受任何手术的 506 例患者中，有 7.9%（506 例）进行了腹腔镜分期检查，其中 29.8%（151 例）患者未进行后续治疗性干预。与行非治疗性剖腹手术的患者相比，仅行腹腔镜分期检查的患者院内死亡率（5.3% vs. 13.1%，p<0.001）和住院时间（2 天 vs. 10 天，p<0.001）明显更低。
在这项大型的基于人群的队列研究中，我们发现腹腔镜分期检查在老年胃腺癌患者的治疗中应用较少。增加腹腔镜分期检查的应用可能会降低与非治疗性剖腹手术相关的大量发病率和死亡率。
