Underutilization of Staging Laparoscopy Prior to Neoadjuvant Systemic Therapy in Gastric Cancer

Area of Science:

• Gastrointestinal Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Radiographically occult peritoneal carcinomatosis (PC) is a significant challenge in gastric cancer management.
• Staging laparoscopy (SL) is recommended before neoadjuvant systemic therapy (NST) to detect PC and prevent understaging.

Purpose of the Study:

• To evaluate the utilization of SL in gastric cancer patients referred to academic institutions.
• To assess the impact of SL on staging and subsequent treatment decisions.

Main Methods:

• Multi-institution retrospective study of gastric/gastroesophageal junction (GEJ) Siewert 3 adenocarcinoma patients (2010-2022).
• Data collected on demographics, tumor characteristics, treatment, and recurrence.
• Descriptive statistics and multivariate analysis performed.

Main Results:

• Of 205 eligible patients, only 39 (29.8%) in the NST group underwent SL.
• 15 patients (38.4%) who had SL were upstaged due to PC (gross or cytologic).
• Peritoneal recurrence was the most common site (38.5%) among patients undergoing resection after NST.

Conclusions:

• Compliance with SL before NST is suboptimal.
• SL identifies significant rates of previously undetected peritoneal carcinomatosis, impacting patient management.
• Improved compliance with SL or alternative methods for PC detection are crucial.