Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Surg Endosc. 2018 Jan;32(1):268-275. doi: 10.1007/s00464-017-5673-z. Epub 2017 Jun 29.
There have been many studies that describe the value of diagnostic staging laparoscopy (DSL) in gastric cancer. However, different studies use different indications, making study results difficult to compare. This study aimed to clarify the diagnostic feasibility of DSL for gastric cancer in a prospective manner and investigated the impact of DSL on clinical decision-making in gastric cancer treatment.
The study was a prospective cohort study based at a single institution between January 2010 and December 2013. We treated 2213 patients with potentially resectable gastric cancer during this period. DSL was primarily indicated for asymptomatic patients with: (1) large Borrmann type 3 tumours ≥8 cm, (2) Borrmann type 4 tumours (linitis plastica), (3) bulky lymph nodes or paraaortic lymph node swelling, or (4) clinical suspicion of peritoneal disease. The primary outcome is change in treatment strategy, and the secondary outcomes are diagnostic accuracy of the indications and false negative rate of DSL.
DSL was performed on 156 (7%) of 2213 patients. Of these, peritoneal disease was found in 74 (47%) patients: (1) 56% for large type 3, (2) 54% for type 4, (3) 21% for bulky lymph nodes or paraaortic lymph node swelling, and (4) 20% for suspected peritoneal disease. The diagnostic accuracy of our indication for DSL was 92% for all patients and 74% for patients with cT3/T4 tumours. Among 82 patients without peritoneal disease, 66 patients (81%) underwent subsequent radical gastrectomy; peritoneal disease was discovered intraoperatively for 7 patients at laparotomy, indicating a false negative rate of 11%.
We confirmed that DSL performed according to our indication, in the context of gastric cancer, possesses diagnostic feasibility. Approximately half of the patients who underwent DSL consequently avoided unnecessary laparotomy and were able to receive appropriate alternative treatment.
有许多研究描述了诊断性腹腔镜分期（DSL）在胃癌中的价值。然而，不同的研究使用不同的适应证，使得研究结果难以比较。本研究旨在前瞻性地阐明 DSL 在胃癌诊断中的可行性，并探讨 DSL 对胃癌治疗临床决策的影响。
本研究是一项单中心前瞻性队列研究，于 2010 年 1 月至 2013 年 12 月进行。在此期间，我们共治疗了 2213 例潜在可切除的胃癌患者。DSL 主要适用于无症状的以下患者：（1）Borrmann Ⅲ型肿瘤≥8cm，（2）Borrmann Ⅳ型肿瘤（皮革胃），（3）大块淋巴结或腹主动脉旁淋巴结肿大，或（4）临床怀疑腹膜疾病。主要结局是治疗策略的改变，次要结局是适应证的诊断准确性和 DSL 的假阴性率。
2213 例患者中，有 156 例（7%）接受了 DSL。其中，74 例（47%）患者发现腹膜疾病：（1）大型 Borrmann Ⅲ型肿瘤的 56%，（2）Borrmann Ⅳ型肿瘤的 54%，（3）大块淋巴结或腹主动脉旁淋巴结肿大的 21%，（4）疑似腹膜疾病的 20%。我们的 DSL 适应证的诊断准确性为所有患者的 92%，cT3/T4 肿瘤患者的 74%。在 82 例无腹膜疾病的患者中，66 例（81%）接受了后续根治性胃切除术；7 例患者在剖腹手术中发现腹膜疾病，假阴性率为 11%。
我们证实，根据我们的适应证，在胃癌背景下，DSL 具有诊断可行性。大约一半接受 DSL 的患者避免了不必要的剖腹手术，并能够接受适当的替代治疗。
