The Current Role of Staging Laparoscopy in Oesophago-gastric Cancer: A six-year review

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Introduction

Oesophago-gastric (OG) is known to spread rapidly to loco-regional lymph nodes and by transcoelomic spread to the peritoneal cavity. Staging laparoscopy (SL) combined with peritoneal cytology can detect advanced disease which may not be apparent on other staging investigations. The aim of this study was to determine the current value of SL and peritoneal cytology in light of the ubiquitous use of computed tomography (CT) in all OG cancers and the addition of positron emission tomography (PET) in oesophageal cancer.

Methods

All patients undergoing staging laparoscopy for distal oesophageal or gastric cancer between March 2007 and August 2013 were identified from a prospectively maintained database. Demographic details, pre-operative staging, SL findings, cytology and histopathology results were analysed.

Results

317 patients were identified. The mean age was 68 (range 24-87). 70.9% of patients were male. 159 patients (50.1%) had gastric adenocarcinoma, 136 (43.0%) oesophageal adenocarcinoma and 22 (6.9%) oesophageal squamous carcinoma. SL upstaged the disease in 41 (25.8%) patients with gastric adenocarcinoma, 22 (16.2%) patients with oesophageal adenocarcinoma and 3 (13.6%) patients with oesophageal squamous carcinoma. Positive peritoneal cytology in the absence of macroscopic peritoneal metastases was identified in 5 (3.1%) patients with gastric adenocarcinoma, 6 (4.4%) with oesophageal adenocarcinoma and 2 (9.1%).with oesophageal squamous carcinoma.

Conclusion

This study has shown that SL alone upstaged the disease in 16.4% of patients with OG cancer. The use of peritoneal cytology upstaged a further 14 patients who had no evidence of macroscopic metastases at the time of SL. We conclude that SL and peritoneal cytology remain vital components in the staging of distal oesophageal and gastric cancer.