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IS ROUTINE STAGING LAPAROSCOPY IN POTENTIALLY RESECTABLE DISEASE JUSTIFIED IN GASTRIC CANCER? A SINGLE UNIT EXPERIENCE.

BACKGROUND: Gastric adenocarcinoma is a heterogenous disease with often a late presentation. Staging laparoscopy (SL) improves the detection of metastases not visible on standard cross-sectional imaging. Routine SL may avoid unnecessary surgical exploration in a significant proportion of patients.

METHOD: A retrospective review of a prospectively maintained database was performed identifying the use of routine SL in patients presenting with potentially resectable gastric (GCA) and oesophagogastric junction (OGJ) adenocarcinoma; with patients presenting between April 2013 and April 2017 to a single surgical unit reviewed.

RESULTS: A total of 323 patients were identified with 14% African, 21% Caucasian and 75% of Coloured ethnicity. Sixty six per cent of GCA and 62% of OGJ cancers were male. The median age of GCA presentation was 63 years (range 31-88 years) and 61 years (range 37-83 years) for OGJ cancers. Ninety six GCA and 24 OGJ patients were deemed potentially resectable following staging CT, with exclusion of 203 patients irresectable on CT or due to patient comorbidities. 121 pyloric and 44 OG junction palliative stents were subsequently placed. Of the 120 resectable patients, 107 were fit and agreeable to surgery with 84 GCA and 23 OGJ patients proceeding to staging laparoscopy. Twenty eight (33%) of resectable GCA and 7 (30%) of resectable OGJ were deemed irresectable after staging laparoscopy due to occult metastatic disease. The remaining 85 patients resectable after staging laparoscopy were referred for neoadjuvant therapy with 50 eventually presenting for curative surgery (35 were not operated due to disease progression or clinical deterioration). A further 15 patients were found at laparotomy to be locally advanced and irresectable.

CONCLUSION: Gastric adenocarcinoma is an aggressive disease presenting late in our environment. Staging laparoscopy should be routinely included in the pre-treatment evaluation, as a third of patients judged resectable on imaging will have occult metastases.

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