Diagnostic Role of Staging Laparoscopy in the Management of Gastro-Esophageal Junction and Gastric Adenocarcinoma

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Objectives: To evaluate the role of staging laparoscopy in the detection of radiological occult peritoneal metastasis in patients with gastro-esophageal junction and gastric adenocarcinoma. Study Design: Prospective observational study Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from Oct 2019 to Jun 2020. Methodology: Patients with cancers of gastro-esophageal junction and gastric adenocarcinoma on histopathology specimen obtained by endoscopy were included in the study. Patients with T1 lesions and those who refused or had medical contraindications for laparoscopy were excluded from the study. Staging Laparoscopy was done in patients with no metastatic disease on CT scan. Peritoneal washings for cytology were taken for all patients undergoing staging laparoscopy. Results: The mean age of study participants was 52.6±13.48 years. There were 67(67.0%) male patients and 33(33.0%) female patients. 23 patients had gastroesophageal junction carcinoma while 77 had gastric adenocarcinoma. 41(41.0%) were positive for metastasis on CT chest/abdomen while no metastasis was detected on imaging in 59(59.0%) patients. So, 59 patients underwent diagnostic laparoscopy, out of which 22(37%) had metastatic disease. Patients had positive peritoneal cytology for malignant cells, 17 had metastasis in peritoneal lesions, 4 patients had lymph node metastasis, and 2 had liver metastasis. Conclusion: The current study indicated staging laparoscopy (SL) as a safe and accurate modality to detect occult peritoneal metastasis in gastric and gastro-esophageal junction cancer patients.

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