Yield of Staging Laparoscopy and Lavage Cytology for Radiologically Occult Peritoneal Carcinomatosis of Gastric Cancer
Yield of Staging Laparoscopy and Lavage Cytology for Radiologically Occult Peritoneal Carcinomatosis of Gastric Cancer
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DOI：
10.1245/s10434-016-5409-7
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发表时间：
2016-12-01
影响因子：
3.7
通讯作者：
Badgwell, Brian D.
中科院分区：
文献类型：
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作者：
Ikoma, Naruhiko;Blum, Mariela;Badgwell, Brian D.
本研究旨在确定胃癌患者腹腔灌洗细胞学分期腹腔镜检查的效果，并随时间进行跟踪。回顾了 1995 年至 2012 年在作者所在机构接受预治疗分期腹腔镜检查的胃或胃食管腺癌患者的医疗记录。腹腔镜检查率定义为腹腔镜检查呈阳性结果的患者比例，包括肉眼可见癌变、细胞学阳性或其他临床重要发现的患者。为了比较随着时间的推移腹腔镜检查的效率，根据诊断日期将患者分为三个 6 年范围。使用单变量和多变量分析检查临床病理因素和腹膜疾病之间的关联。该研究包括 711 名患者。这些患者中，43.5%患有胃食管交界部肿瘤，72.9%患有低分化腺癌，53%患有印戒细胞形态。超声内镜最常发现 T3 (83.9 %) 和 N 阳性 (66.4 %) 肿瘤。在腹腔镜检查中，148 名患者（20.8%）被发现患有肉眼可见的腹膜癌病。在 514 名接受腹腔灌洗细胞学分析的宏观阴性患者中，68 名（13.2%）的恶性肿瘤细胞学结果呈阳性。腹腔镜总检出率为 36%，不随时间变化 (p = 0.58)。多变量分析表明，阳性细胞学或癌病与分化差的组织学、塑料性皮炎和模棱两可的计算机断层扫描结果相关。即使目前有高质量成像，腹腔镜检查仍然是在考虑治疗或手术时评估腹膜扩散的有用分期方法。
This study aimed to identify the yield of staging laparoscopy with peritoneal lavage cytology for gastric cancer patients and to track it over time.The medical records of patients with gastric or gastroesophageal adenocarcinoma who underwent pretreatment staging laparoscopy at the authors' institution from 1995 to 2012 were reviewed. The yield of laparoscopy was defined as the proportion of patients who had positive findings on laparoscopy, including those with macroscopic carcinomatosis, positive cytology, or other clinically important findings. To compare the yield of laparoscopy over time, the patients were divided into three 6-year ranges based on the date of diagnosis. Associations between clinicopathologic factors and peritoneal disease were examined using uni- and multivariate analyses.The study included 711 patients. Among these patients, 43.5 % had gastroesophageal junction tumors, 72.9 % had poorly differentiated adenocarcinoma, and 53 % had signet ring cell morphology. Endoscopic ultrasound had most commonly identified T3 (83.9 %) and N-positive (66.4 %) tumors. At laparoscopy, 148 (20.8 %) patients had been found to have macroscopic peritoneal carcinomatosis. Among 514 macroscopically negative patients who underwent peritoneal lavage cytologic analysis, 68 (13.2 %) had positive cytology results for malignancy. The total laparoscopy yield was 36 %, which did not change over time (p = 0.58). Multivariate analysis demonstrated that positive cytology or carcinomatosis was associated with poorly differentiated histology, linitis plastica, and equivocal computed tomography findings.Laparoscopy remains a useful staging procedure to evaluate for peritoneal spread when treatment or surgery is considered, even with the current availability of high-quality imaging.