BACKGROUND: Staging laparoscopy can detect radiographically occult peritoneal metastases and prevent futile laparotomy in patients with gastric adenocarcinoma. We sought to assess the use of staging laparoscopy for gastric adenocarcinoma in a cohort of older patients and to compare outcomes after laparoscopy alone with nontherapeutic laparotomy. STUDY DESIGN: Using Surveillance, Epidemiology and End Results (SEER) population-based cancer registry data linked with Medicare claims, we identified patients aged 65 or older diagnosed with gastric adenocarcinoma between 1998 and 2005. We defined staging laparoscopy as a laparoscopic procedure from 1 month before the date of diagnosis until death and futile laparotomy as a laparotomy in the absence of a therapeutic intervention. We examined trends in the use of staging laparoscopy and compared outcomes between patients who underwent staging laparoscopy alone and those who had a futile laparotomy. RESULTS: Of 11,759 patients with gastric adenocarcinoma, 6,388 (54.3%) had at least 1 surgical procedure. Staging laparoscopy was performed in 506 (7.9%) patients who had any surgery, and 151 (29.8%) of these patients did not have a subsequent therapeutic intervention. Patients who underwent staging laparoscopy alone had a significantly lower rate of in-hospital mortality (5.3% vs 13.1%, p < 0.001) and shorter length of hospitalization (2 vs 10 days, p < 0.001) than patients who had futile laparotomy. CONCLUSIONS: Our findings in this large, population-based cohort suggest that staging laparoscopy is used infrequently in the management of older patients with gastric adenocarcinoma. Increased use of staging laparoscopy could reduce the substantial morbidity and mortality associated with nontherapeutic laparotomy.
BACKGROUND: Staging laparoscopy can detect radiographically occult peritoneal metastases and prevent futile laparotomy in patients with gastric adenocarcinoma. We sought to assess the use of staging laparoscopy for gastric adenocarcinoma in a cohort of older patients and to compare outcomes after laparoscopy alone with nontherapeutic laparotomy. STUDY DESIGN: Using Surveillance, Epidemiology and End Results (SEER) population-based cancer registry data linked with Medicare claims, we identified patients aged 65 or older diagnosed with gastric adenocarcinoma between 1998 and 2005. We defined staging laparoscopy as a laparoscopic procedure from 1 month before the date of diagnosis until death and futile laparotomy as a laparotomy in the absence of a therapeutic intervention. We examined trends in the use of staging laparoscopy and compared outcomes between patients who underwent staging laparoscopy alone and those who had a futile laparotomy. RESULTS: Of 11,759 patients with gastric adenocarcinoma, 6,388 (54.3%) had at least 1 surgical procedure. Staging laparoscopy was performed in 506 (7.9%) patients who had any surgery, and 151 (29.8%) of these patients did not have a subsequent therapeutic intervention. Patients who underwent staging laparoscopy alone had a significantly lower rate of in-hospital mortality (5.3% vs 13.1%, p < 0.001) and shorter length of hospitalization (2 vs 10 days, p < 0.001) than patients who had futile laparotomy. CONCLUSIONS: Our findings in this large, population-based cohort suggest that staging laparoscopy is used infrequently in the management of older patients with gastric adenocarcinoma. Increased use of staging laparoscopy could reduce the substantial morbidity and mortality associated with nontherapeutic laparotomy.
Authors: Celina Ang; Yelena Y Janjigian; Ali Shamseddine; Ayman Tawil; Maeve A Lowery; Andrew Intlekofer; Walid Faraj; Ashwaq Al-Olayan; Laura Tang; Eileen M O'Reilly; Fady Geara; Aghiad Al-Kutoubi; David P Kelsen; Ghassan K Abou-Alfa Journal: Gastrointest Cancer Res Date: 2012-03
Authors: Ibrahim Nassour; Hannah Fullington; Linda S Hynan; Adam C Yopp; Mathew M Augustine; Patricio M Polanco; Michael A Choti; John C Mansour; Sam C Wang; Matthew R Porembka Journal: Ann Surg Oncol Date: 2017-02-13 Impact factor: 5.344
Authors: Lisette T Hoekstra; Matthanja Bieze; Olivier R C Busch; Dirk J Gouma; Thomas M van Gulik Journal: Surg Endosc Date: 2012-10-06 Impact factor: 4.584
Authors: Eric M Groh; Shreya Gupta; Zachary J Brown; Lindsey Enewold; Lauren A Gamble; Jonathan M Hernandez; Jeremy L Davis Journal: Ann Surg Oncol Date: 2019-11-20 Impact factor: 5.344
Authors: Cornelius A Thiels; Naruhiko Ikoma; Keith Fournier; Prajnan Das; Mariela Blum; Jeannelyn S Estrella; Bruce D Minsky; Jaffer Ajani; Paul Mansfield; Brian D Badgwell Journal: J Surg Oncol Date: 2018-06-07 Impact factor: 3.454
Authors: Sam C Wang; Joanne F Chou; Vivian E Strong; Murray F Brennan; Marinela Capanu; Daniel G Coit Journal: Ann Surg Date: 2016-02 Impact factor: 12.969