Hosogi Hisahiro, Shinohara Hisashi, Tsunoda Shigeru, Hisamori Shigeo, Sumida Hitoshi, Hida Koya, Obama Kazutaka, Okabe Hiroshi, Sakai Yoshiharu
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
Langenbecks Arch Surg. 2017 Feb;402(1):33-39. doi: 10.1007/s00423-016-1536-7. Epub 2016 Nov 29.
Although the use of staging laparoscopy (SL) for detecting peritoneal metastasis (P) and determining peritoneal lavage cytology (CY) is widespread in advanced gastric cancer, an indication for SL based on preoperative clinicopathological factors is controversial.
From May 2006 to September 2015, 120 patients with advanced gastric cancer with primary tumors ≥5 cm and/or with bulky regional lymph nodes (bulky N) underwent SL for assessment of P/CY status. Clinicopathological factors were analyzed retrospectively to determine their influence on peritoneal spread (P1 and/or CY1). An additional analysis of 379 consecutive patients with clinically T2 or deeper gastric cancer in the same time period was carried out to confirm the SL results.
Peritoneal spread was confirmed by SL in 54 cases (45%). The presence of type-4 tumors (n = 38, p < 0.0001) and diffuse-type tumors (n = 85, p = 0.04) correlated significantly with peritoneal spread. These two factors were also correlated significantly with increased peritoneal spread in a subgroup analysis among patients with tumors with bulky N (n = 44). The additional analysis of 379 patients showed results consistent with the SL results. The frequency of peritoneal spread was 78% among type-4 tumors, 47% among diffuse-type tumors ≥5 cm, and 38% among diffuse-type tumors with bulky N, whereas among intestinal-type tumors, it was 18% in tumors ≥5 cm and 13% among tumors with bulky N.
Among tumors ≥5 cm or with bulky N, type-4 tumors and diffuse-type tumors had a high potential for peritoneal spread and patients with such tumors were considered more suitable candidates for SL.
尽管分期腹腔镜检查（SL）用于检测晚期胃癌的腹膜转移（P）和确定腹腔灌洗细胞学检查（CY）的应用广泛，但基于术前临床病理因素的SL指征仍存在争议。
2006年5月至2015年9月，120例原发性肿瘤≥5 cm和/或伴有肿大区域淋巴结（肿大N）的晚期胃癌患者接受了SL以评估P/CY状态。回顾性分析临床病理因素以确定其对腹膜扩散（P1和/或CY1）的影响。同期对另外379例临床T2期或更深层胃癌患者进行了分析以证实SL结果。
SL证实54例（45%）存在腹膜扩散。4型肿瘤（n = 38，p < 0.0001）和弥漫型肿瘤（n = 85，p = 0.04）的存在与腹膜扩散显著相关。在伴有肿大N的肿瘤患者亚组分析中，这两个因素也与腹膜扩散增加显著相关（n = 44）。对379例患者的额外分析结果与SL结果一致。4型肿瘤中腹膜扩散的频率为78%，≥5 cm的弥漫型肿瘤中为47%，伴有肿大N的弥漫型肿瘤中为38%，而在肠型肿瘤中，≥5 cm的肿瘤中为18%，伴有肿大N的肿瘤中为13%。
在肿瘤≥5 cm或伴有肿大N的患者中，4型肿瘤和弥漫型肿瘤具有较高的腹膜扩散可能性，此类肿瘤患者被认为更适合进行SL。
