Role of repeat staging laparoscopy in locoregionally advanced gastric or gastroesophageal cancer after neoadjuvant therapy

Background: Nowadays there are no international recommendations regarding the necessity of repeated diagnostic laparoscopy (with cytological examination or without it) after preoperative chemotherapy for resectable gastric cancer Purpose: To determine the indications for the repeated laparoscopic surgery in gastric or gastroesophageal cancer patients

Materials and methods: The information on 449 IB-III stage gastric cancer patients was analyzed. After 4 cycles of chemotherapy 52 patients underwent diagnostic laparoscopy with peritoneal fluid cytology testing.

Results: The multifactorial analysis showed that tumor progression detected on CT scans and gastroscopy, subtotal gastric involvement (p < 0,014), and diffuse Lauren type (p < 0,026) were statistically significant negative prognostic factors after preoperative chemotherapy. The 8 weeks interval after neoadjuvant chemotherapy wasn’t significant.

Results: The repeat staging laparoscopy after neoadjuvant chemotherapy is safe and may be considered for a certain category of patients.

1. Jamel S., Markar S.R., Malietzis G., et al. Prognostic significance of peritoneal lavage cytology in staging gastric cancer: systematic review and meta-analysis. Gastric Cancer 2018;21(l):10-18. https://doi.org/10.1007/sl0120-017-0749-y

2. Cunningham D., Allum W.H., Stenning S.P., et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355(l):ll-20. https://doi.org/10.1056/NEJMoa055531

3. Ychou M., Boige V., Pignon J.P., et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011;29(13):1715—21. https://doi.org/10.1200/JCO.2010.33.0597

4. van Hagen P., Hulshof M.C., van Lanschot J.J., et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366(22):2074-84. https://doi.org/10.1056/NEJMoalll2088

5. Ronellenfitsch U., Schwarzbach M., Hofheinz R., et al. Preoperative chemo (radio) therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. EurJ Cancer 2013;49(15):3149-58. https://doi.Org/10.1016/j.ejca.2013.05.029

6. Schuhmacher C., Gretschel S., Lordick F., et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 2010;28(35):5210-18. https://doi.org/10.1200/JCO.2009.26.6114

7. Lordick F., Carneiro F., Cascinu S., et al. Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022;33(10):1005-1020. https://doi.Org/10.1016/j.annonc.2022.07.0042022

8. Clinical Guidelines. Gastric cancer, 2020. Available at: https://oncology-association.ru/wp-content/uploads/2020/09/rak_zheludka.pdf (In Russ.)

9. NCCN guidelines. Gastric cancer, 2024. Available at: https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf.

10. TNM: Классификация злокачественных опухолей. Под ред. Дж.Д. Брайерли и др.; пер. с англ, и научи, ред. Е.А. Дубовой, К.А. Павлова. 2-е изд. на русском языке. — М.: Логосфера, 2018. — 344 с.

11. Cardona К., Zhou Q., Gonen М., et al. Role of repeat staging laparoscopy in locoregionally advanced gastric or gastroesophageal cancer after neoadjuvant therapy. Ann Surg Oncol 2013;20(2):548-554. https://doi.org/10.1245/sl0434012-2598-6

12. Thiels C.A., Ikoma N., Fournier K., et al. Repeat staging laparoscopy for gastric cancer after preoperative therapy. J Surg Oncol 2018;118(l):61-67. https://doi.org/10.1002/jso.25094

13. Kwee R.M., Kwee T.C. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol 2007;25(15):2107-2116. https://doi.org/10.1200/JCO.2006.09.5224