Factors associated with peritoneal carcinomatosis due to gastric cancer: On whom do we perform laparoscopy?
Keywords:
Gastric cancer, Staging laparoscopy, CarcinomatosisAbstract
Introduction: Several studies have demonstrated the effectiveness of laparoscopy in the evaluation of patients with advanced tumours. However, there is no uniformity with respect to its systematic use, with different authors having reported variable indications and outcomes.
Methods: An observational, analytical, cross-sectional study in which a model was evaluated with a group of variables associated with the laparoscopic diagnosis of peritoneal carcinomatosis. The study included all patients with gastric adenocarcinoma who were submitted to staging laparoscopy from January 2008 until the sample was completed, which was estimated in 153 cases. The variables evaluated were age, gender, weight loss, serum albumin value, endoscopic tumour location, histological type, according to Lauren classification and tumour tomography (T), presence of lymphadenopathy (N), and ascites. The presence of peritoneal carcinomatosis was defined by laparoscopic observation.
Results: A total of 153 cases of gastric adenocarcinoma patients submitted to staging laparoscopy were analysed in the Gastrointestinal Surgery Department of the National Cancer Institute.
They included 102 men (66%) and 51 women (33%), aged between 28 and 86 years. Statistically significant factors associated with the presence of peritoneal carcinomatosis were, age less than 65 years (OR = 2.0, 95% CI: 1 - 4.2), female gender (OR 2.2, 95% CI: 1.06 (OR = 2.6, 95% CI: 1.25 - 5.2), presence of ascites (OR = 4.3, 95% CI: 1.3 - 15.9), and histology of the diffuse type (OR 3.0; 95% CI: 1.5 - 5.8).
Conclusions: Staging laparoscopy is a valuable tool in the initial approach of patients with advanced gastric cancer, and imaging studies do not replace it. Women, younger than 65 years, with gastroesophageal junction (GEJ) tumours, of the diffuse histological type, and with documented ascites in computed tomography scan, are at greater risk of peritoneal carcinomatosis at the time of diagnosis. Thus, the systematic use of staging laparoscopy is proposed in patients who meet one or more of these characteristics.
Author Biographies
Raúl Pinilla, Instituto Nacional de Cancerología
Servicio de Cirugía Gastrointestinal y Endoscopia Digestiva, Instituto Nacional de Cancerología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia
Helena Facundo, Universidad Nacional de Colombia
Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia
Ricardo Oliveros, Instituto Nacional de Cancerología
Servicio de Cirugía Gastrointestinal y Endoscopia Digestiva, Instituto Nacional de Cancerología, Bogotá, D.C, Colombia
Ricardo Sánchez, Instituto Nacional de Cancerología
Facultad de Medicina, Universidad Nacional de Colombia,Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá, D.C, Colombia
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