The role of staging laparoscopy in stage IV gastric cancer patients

Introduction: Evidence regarding staging laparoscopy(SL)for clinical metastatic(cM+)gastric cancer(GC)patients is limited. Recently,Italian Gastric Cancer Research Group(GIRCG)study showed SL changed peritoneal status in over 20% of cases. This study aims to evaluate SL's role in cM+ patients and refine indications. Methods: Data of cM+ GC patients who underwent SL between 2010 and 2022 at nine GIRCG Centers were retrospectively analyzed.Primary outcome was SL's yield,defined as peritoneal status changed by SL,over all SLs. Results: Among 182 cM+ patients who received SL,38(20.9%)had SL-findings changing peritoneal status.10.1% of cases with preoperative signs of peritoneal carcinomatosis(PC)had no peritoneal disease,while 46.3% with extraperitoneal disease alone had PC at SL.Thirty-one patients(17.0%)underwent R0 resection:17(54.8%)with PC,3(9.7%)with liver metastases,4(12.9%)with PC and nodal metastases,2(6.4%)with lung and 1(3.2%)with bone metastases.17 patients with suspected preoperative PC underwent curative treatment:9 had peritoneal disease ruled out by SL,other 8 had limited PC,allowing R0 resection.Logistic regression revealed inverse correlation between diffuse histotype and absence of PC at SL,in patients with peritoneal involvement at imaging(p=0.02). Conclusions: SL aids in directing cM+ GC patients to appropriate treatment,with a 20.9% yield.For those with peritoneal involvement at imaging,SL helps identify candidates for curative treatment.In patients with extraperitoneal disease,SL should be considered to assess potential radical strategies.