Annals of surgical oncology · 2026
The Clinical Value of Laparoscopic Exploration in Diagnosing and Dynamically Assessing Occult Peritoneal Metastasis in Gastric Cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Yan Xiao, Xie Qing, Li Fengping, Liang Huayuan, Li Zhiwei, Huang Kaihua, Zhang Huimin, Zhong Rou, Lai Min, Liu Xinru, Yu Jiang, Zhao Liying
Аннотация
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.
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.