Alcasid Nathan J, Fink Deanna, Banks Kian C, Susai Cynthia J, Barnes Katherine, Wile Rachel, Sun Angela, Patel Ashish, Ashiku Simon, Velotta Jeffrey B
Department of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Ann Surg Oncol. 2025 Jan;32(1):258-264. doi: 10.1245/s10434-024-15862-0. Epub 2024 Nov 6.
The efficacy of routine diagnostic laparoscopy with cytologic evaluation for gastroesophageal junction (GEJ) cancer is variable with no set guidelines. We hypothesize that findings from diagnostic laparoscopy in Siewert II and III GEJ tumors may differ, where routine diagnostic laparoscopy with washings yields low upstaging results in Siewert II compared with Siewert III tumors.
We reviewed patients with Siewert II/III GEJ cancer from 2012 through 2022 within our integrated health system. Chi-squared, Fisher's exact, and two-sample Wilcoxon rank-sum tests were utilized. The outcomes measured include likelihood of upstaging, cytology positivity, times to chemotherapy and surgery, and 5-year mortality using a multivariable Cox regression model.
Of 265 patients with Siewert II diagnosis, 116 patients underwent a diagnostic laparoscopy while 149 patients did not. Median time to chemotherapy initiation and definitive surgery were increased among patients with diagnostic laparoscopy, with no difference observed in 5-year survival. For patients with Siewert II and III with a diagnostic laparoscopy, 5% of Siewert II were upstaged, compared with 17% of Siewert III (p = 0.025). Obtaining cytologic washings alone were less likely to be upstaged compared with receiving a biopsy with or without washings (5.2% vs. 17.3%, p = 0.039), and those with Siewert II were less likely than Siewert III to be upstaged after diagnostic laparoscopy (5.2% vs. 17.4%, p = 0.025).
Routine diagnostic laparoscopy yields a low upstaging rate in Siewert II GEJ adenocarcinomas (AC) while delaying treatment with no improvement on mortality. Expediting definitive surgery with selective biopsy in lieu of diagnostic laparoscopy may improve oncologic outcomes.
常规诊断性腹腔镜检查联合细胞学评估对胃食管交界部（GEJ）癌的疗效存在差异，尚无既定指南。我们假设，在Siewert II型和III型GEJ肿瘤中，诊断性腹腔镜检查的结果可能不同，与Siewert III型肿瘤相比，Siewert II型肿瘤采用常规诊断性腹腔镜检查联合冲洗液检查的分期上调结果较低。
我们回顾了2012年至2022年在我们综合医疗系统中诊断为Siewert II/III型GEJ癌的患者。采用卡方检验、Fisher精确检验和两样本Wilcoxon秩和检验。测量的结果包括分期上调的可能性、细胞学阳性率、化疗和手术时间，以及使用多变量Cox回归模型的5年死亡率。
在265例诊断为Siewert II型的患者中，116例接受了诊断性腹腔镜检查，149例未接受。接受诊断性腹腔镜检查的患者开始化疗和确定性手术的中位时间增加，5年生存率无差异。在接受诊断性腹腔镜检查的Siewert II型和III型患者中，Siewert II型患者分期上调的比例为5%，而Siewert III型患者为17%（p = 0.025）。与接受活检（无论有无冲洗液）相比，仅获取细胞学冲洗液分期上调的可能性较小（5.2%对17.3%，p = 0.039），并且Siewert II型患者在诊断性腹腔镜检查后分期上调的可能性低于Siewert III型患者（5.2%对17.4%，p = 0.025）。
常规诊断性腹腔镜检查在Siewert II型GEJ腺癌（AC）中的分期上调率较低，同时延迟治疗且死亡率无改善。采用选择性活检代替诊断性腹腔镜检查加快确定性手术可能会改善肿瘤学结局。
