Related Experiment Video
Updated: Jun 3, 2026
Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma
Published on: August 9, 2016
The Clinical Value of Laparoscopic Exploration in Diagnosing and Dynamically Assessing Occult Peritoneal Metastasis
Xiao Yan1, Qing Xie1, Fengping Li1
1Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Background:
Imaging-invisible occult peritoneal metastasis (OPM) is not uncommon in patients with gastric or gastroesophageal junction adenocarcinoma (G/GEJC). This study aimed to identify the risk factors for OPM detected by laparoscopic exploration, characterize the dynamic changes in OPM on laparoscopic re-exploration after treatment, and evaluate their prognostic significance.
Methods:
The study included 653 patients with newly diagnosed cT1-2N+/T3-4bNx, cM0 G/GEJC who underwent laparoscopic exploration and peritoneal lavage fluid cytology between July 2018 and June 2025. Of these 653 patients, 140 underwent repeat laparoscopy (the laparoscopic re-exploration cohort) with cytology after systemic therapy. Risk factors for OPM were identified by logistic regression and survival by Kaplan-Meier analysis.
Results:
On initial laparoscopy, 22.2% (145/653) of the patients received a diagnosis of OPM+, whereas 77.8% (508/653) received a diagnosis of OPM-. Younger patients (age < 35 years), better Eastern Cooperative Oncology Group (ECOG) status (0 score), primary gastric cancers, CA72-4 (≥ 6.9 U/mL), sT4a/b stage, and minimal ascites (vs no ascites) were associated with OPM+. Patients with OPM+ initially had significantly worse median overall survival than OPM- patients (15.9 months vs not reached; P < 0.001). In the laparoscopic re-exploration cohort, 26.4% (37/140) showed changes in OPM status. Specifically, among the initial OPM+ patients, 57.1% (16/28) were converted to OPM-, whereas 18.8% (21/112) of the initial OPM- patients were converted to OPM+. Persistent OPM- and conversion to OPM- were associated with better survival than persistent OPM+ and conversion to OPM+.
Conclusion:
In locally advanced G/GEJC, OPM is common. Laparoscopic exploration is essential for detecting OPM, and dynamic laparoscopic evaluation of peritoneal metastasis status holds significant prognostic value.
