Introduction Radiographically occult peritoneal carcinomatosis (PC) is a well-recognised challenge in gastric and Siewert III gastroesophageal junction adenocarcinoma. Current guidelines recommend staging laparoscopy (SL) before neoadjuvant systemic therapy (NST) to prevent understaging and inappropriate treatment.
Introduction
Radiographically occult peritoneal carcinomatosis (PC) is a well-recognised challenge in gastric and Siewert III gastroesophageal junction adenocarcinoma. Current guidelines recommend staging laparoscopy (SL) before neoadjuvant systemic therapy (NST) to prevent understaging and inappropriate treatment.
Problem Statement
Despite clear recommendations, real-world adherence to SL remains uncertain. Missing occult peritoneal metastases may expose patients to unnecessary chemotherapy, surgery, and delayed palliative care.
Study Findings
In this multi-institution retrospective analysis of 205 non–stage IV patients (2010–2022), 63% received NST. However, only 29.8% underwent staging laparoscopy before NST. Among those who had SL, 38% were upstaged due to peritoneal metastases—80% with gross PC and 20% with positive cytology.
Among patients proceeding to surgery after NST, recurrence occurred in 33.7%, with the peritoneum as the most common site (38.5%), highlighting the clinical relevance of missed peritoneal disease.
Conclusion
SL is significantly underutilised before NST in gastric cancer. Given that nearly 4 in 10 patients undergoing SL were upstaged, improving compliance is critical. Enhanced adherence to SL—or development of better non-invasive detection strategies—may prevent futile therapy and optimise treatment selection in gastric cancer.
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