Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands.
Eur J Surg Oncol. 2021 Jun;47(6):1441-1448. doi: 10.1016/j.ejso.2020.11.011. Epub 2020 Nov 17.
Studies on the value of a staging laparoscopy in detecting metastases in gastric cancer patients show great variation. This study investigates the avoidable surgery rate in patients with and without a staging laparoscopy scheduled for surgery with curative intent.
This population-based cohort study included all patients with an intentional resection for a potentially curable gastric adenocarcinoma, between 2011 and 2016, registered in the Dutch Upper GI Cancer audit. Patients with and without a staging laparoscopy were compared. The primary outcome was the avoidable surgery rate (detection of metastases and/or locoregional non-resectable tumor during intentional gastrectomy). Secondary outcomes were the negative predictive value, postoperative morbidity and pathology parameters.
2849 patients who underwent an intentional gastrectomy were included. 414 of 2849 (14.5%) patients underwent a staging laparoscopy before initiation of treatment. The avoidable surgery rate was 16.2% in the staging laparoscopy group, compared to 8.5% in the non-staging group (P < 0.001), resulting in a negative predictive value of 83.8%. The avoidable surgery rate remained significantly different after correction for possible confounders. The main reason for not executing the gastrectomy was the presence of distant metastasis in both groups. cT and cN stage were significantly higher in patients who underwent a staging laparoscopy.
The staging laparoscopy group had a higher cTN and pTN stage, implicating selection of patients with more advanced disease for a staging laparoscopy. Despite the staging laparoscopy, a higher rate of avoidable surgery was found, suggesting a low sensitivity for detecting metastases or locoregional non-resectability in this patient group.
关于在胃癌患者中进行分期腹腔镜检查以检测转移的价值的研究结果差异很大。本研究旨在调查有计划进行根治性手术的患者与无计划进行分期腹腔镜检查的患者之间可避免手术率。
本基于人群的队列研究纳入了 2011 年至 2016 年间在荷兰上消化道癌症审计中登记的所有接受潜在可治愈胃腺癌切除术的患者。比较了有和无分期腹腔镜检查的患者。主要结局是可避免手术率（在有意行胃切除术时检测到转移和/或局部不可切除肿瘤）。次要结局是阴性预测值、术后发病率和病理参数。
共纳入 2849 例接受意向性胃切除术的患者。2849 例患者中有 414 例行分期腹腔镜检查。分期腹腔镜检查组的可避免手术率为 16.2%，而非分期组为 8.5%（P<0.001），阴性预测值为 83.8%。在纠正可能的混杂因素后，可避免手术率仍存在显著差异。两组均因远处转移而无法行胃切除术。分期腹腔镜检查组的 cT 和 cN 分期明显更高。
分期腹腔镜检查组的 cTN 和 pTN 分期更高，提示对分期腹腔镜检查的患者选择了更晚期的疾病。尽管进行了分期腹腔镜检查，但仍发现了更高的可避免手术率，这表明在该患者组中，对转移或局部不可切除性的敏感性较低。
