Staging laparoscopy in gastroesophageal and gastric adenocarcinoma: first experience from Pakistan

Current NCCN guidelines do not consider staging laparoscopy mandatory for detection of metastasis in gastroesophageal junction (GEJ) and gastric cancer.

To determine the rate of detection of metastasis on staging laparoscopy in GEJ and gastric cancer in Pakistani population and determine the prognostic significance of cytology versus biopsy positive metastatic disease.

Retrospective study conducted from January 2005 to June 2013.

Demographics, clinicopathological characteristics and laparoscopic findings of 149 patients were compared.

Categorical variables were represented as frequencies and percentages and significance was determined using Chi square test. Overall survival was calculated from the date of staging laparoscopy to the date of death/last follow-up. Survival for cytology versus biopsy positive metastatic disease was calculated using Kaplan Meier curves and significance determined with Log rank test.

Overall, metastases were detected in 40% of patients on staging. Laparoscopy detected metastasis in significantly high number of gastric cancers (48% versus 28%) (P = 0.01). Peritoneal nodules were more frequent with gastric tumors (40% versus 23%) and also were more likely to be malignant (58% versus 35%). Expected one year survival in patients with positive cytology (peritoneal washing/ascitic fluid) was significantly higher than patients with a positive peritoneal nodule biopsy (29% versus 0) (P = 0.04). On univariate analysis this was the only significant factor for increased risk of death (P = 0.03, HR = 2.5, CI = 1.04-5.98).

Staging laparoscopy detects metastatic disease in a significant number of patients deemed non metastatic on preoperative imaging. Prognostically, cytology positive metastatic cancer may be different from biopsy positive cancer.