Staging laparoscopy in the management of gastric cancer: A population-based analysis Journal Article


Authors: Karanicolas, P. J.; Elkin, E. B.; Jacks, L. M.; Atoria, C. L.; Strong, V. E.; Brennan, M. F.; Coit, D. G.
Article Title: Staging laparoscopy in the management of gastric cancer: A population-based analysis
Abstract: 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. © 2011 American College of Surgeons.
Keywords: treatment outcome; aged; aged, 80 and over; major clinical study; united states; cancer staging; neoplasm staging; laparoscopy; laparotomy; adenocarcinoma; cohort studies; clinical assessment; medicare; length of stay; hospitalization; gastrectomy; cancer registry; seer program; stomach adenocarcinoma; stomach neoplasms; hospital mortality; medical futility; medical record linkage
Journal Title: Journal of the American College of Surgeons
Volume: 213
Issue: 5
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2011-11-01
Start Page: 644
End Page: 651.e1
Language: English
DOI: 10.1016/j.jamcollsurg.2011.07.018
PROVIDER: scopus
PUBMED: 21872497
DOI/URL:
Notes: --- - "Export Date: 9 December 2011" - "CODEN: JACSE" - "Source: Scopus"
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MSK Authors
  1. Murray F Brennan
    759 Brennan
  2. Elena B Elkin
    149 Elkin
  3. Vivian Strong
    144 Strong
  4. Daniel Coit
    415 Coit
  5. Coral Lynn Atoria
    49 Atoria
  6. Lindsay Jacks
    37 Jacks