Tourani Saam S, Cabalag Carlos, Link Emma, Chan Steven T F, Duong Cuong P
Department of Surgery, Western Health, Footscray, Victoria, Australia.
ANZ J Surg. 2015 Jan;85(1-2):69-73. doi: 10.1111/ans.12197. Epub 2013 May 6.
Previous studies have suggested that patients with occult peritoneal metastases not seen on preoperative imaging have poor prognosis. In this study, we aim to evaluate the utility and impact of staging laparoscopy and peritoneal cytology in patients with gastric adenocarcinoma.
A retrospective analysis of patients with gastric adenocarcinoma managed at two major metropolitan hospitals in Melbourne, Australia, between January 1999 and July 2010 was undertaken. The main outcome measures were the number of patients in whom laparoscopy and/or peritoneal cytology changed treatment intent, and the overall survival of patients with occult metastases detected by laparoscopy/cytology.
Staging laparoscopy as an independent procedure was performed in 74.3% (148/199) of patients who had neither unequivocal metastases (M1) on preoperative imaging nor early T1 disease on endoscopic ultrasound. Laparoscopy/cytology detected occult metastases in 38 (25.6%) patients (27 macroscopic M1 and 11 microscopic M1 with positive peritoneal cytology only), leading to change in the treatment intent in 37 cases. The median overall survivals of patients with metastatic disease detected at staging laparoscopy (8.3 months, 95% confidence interval (CI) 5.4-16.5) or on peritoneal cytology (4.9 months, 95% CI 4.2-48) were as poor as those with M1 disease seen on preoperative imaging (6.7 months, 95% CI 4.2-8.9), P = 0.97.
Laparoscopy and peritoneal cytology add incremental value to modern imaging in the staging of gastric adenocarcinomas by detecting occult metastatic disease. Their utility needs to be optimized to allow better treatment selection for gastric cancer patients.
既往研究表明，术前影像学检查未发现的隐匿性腹膜转移患者预后较差。在本研究中，我们旨在评估分期腹腔镜检查及腹膜细胞学检查在胃腺癌患者中的应用价值及影响。
对1999年1月至2010年7月间在澳大利亚墨尔本两家主要都市医院接受治疗的胃腺癌患者进行回顾性分析。主要观察指标为腹腔镜检查和/或腹膜细胞学检查改变治疗意向的患者数量，以及通过腹腔镜检查/细胞学检查发现隐匿性转移患者的总生存期。
在术前影像学检查未发现明确转移（M1）且内镜超声检查未发现早期T1疾病的患者中，74.3%（148/199）接受了分期腹腔镜检查。腹腔镜检查/细胞学检查在38例（25.6%）患者中发现了隐匿性转移（27例为宏观M1，11例为微观M1，仅腹膜细胞学检查阳性），导致37例患者的治疗意向发生改变。分期腹腔镜检查发现转移疾病患者（8.3个月，95%置信区间[CI]5.4 - 16.5）或腹膜细胞学检查发现转移疾病患者（4.9个月，95%CI 4.2 - 48）的中位总生存期与术前影像学检查发现M1疾病患者（6.7个月，95%CI 4.2 - 8.9）一样差，P = 0.97。
腹腔镜检查和腹膜细胞学检查通过检测隐匿性转移疾病，为现代影像学在胃腺癌分期中增加了额外价值。它们的应用需要优化，以便为胃癌患者选择更好的治疗方案。
