The Role of Diagnostic Laparoscopy in Advanced Gastric Cancer

Abstract

Introduction: Despite modern imaging, a significant proportion of patients with locally advanced gastric cancer are found to have occult peritoneal metastases at exploration. Diagnostic laparoscopy before planned curative resection may prevent non-therapeutic laparotomy. This review assesses its diagnostic yield and impact on management.

Methods: A literature review was performed for studies reporting the yield of diagnostic laparoscopy in patients with gastric cancer deemed resectable by cross-sectional imaging. Outcomes were the proportion of patients with occult peritoneal or liver metastases and the subsequent change in management.

Results: Twenty-three studies (over five thousand patients) were reviewed. The overall yield of occult metastatic disease was fifteen to thirty percent, highest for T3/T4 tumors and signet-ring histology. Laparoscopy changed management in over ninety percent of positive findings, converting planned resection to palliative chemotherapy or supportive care. Minor complications occurred in less than five percent.

Discussion: The yield varies with institutional staging practices. Staging laparoscopy with peritoneal lavage cytology can also detect positive cytology without visible nodules, which also portends poor prognosis. Newer techniques such as near-infrared fluorescence with ICG may improve sensitivity. Routine use may be most cost-effective in patients with high-risk features.

Conclusions: Diagnostic laparoscopy should be performed routinely before laparotomy for locally advanced gastric cancer to detect occult peritoneal disease and avoid unnecessary surgery.