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The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Gastric cancer is a heterogeneous disease with variable presentation between racial and ethnic groups. Staging laparoscopy (SL) detects occult metastases not visible on cross-sectional imaging and therefore improves staging. It remains unclear how differences in race and ethnicity affect disease presentation and the yield of SL.

Methods

We performed a retrospective review of a prospectively maintained database to identify patients with gastric cancer treated with curative intent at our institutions from 2008 to 2015.

Results

Hispanic patients presented at an earlier mean age (55.5 ± 11.9 years) compared with Asian (59.8 ± 13.9 years), African American (61.0 ± 10.0 years), and white patients (61.7 ± 12.5 years; p = 0.046) and with more locally advanced disease (clinical stage T3/T4 or node positive; Hispanic 87%; African American 79%; white 68%, Asian 55%; p = 0.03). SL identified 42 patients (34%) with occult metastatic disease. Hispanics were more likely to have a positive SL (44%) than white patients (21%; p = 0.04). On univariate analysis, Hispanic ethnicity, clinical T3/T4, positive nodal disease, signet ring cells, and poor differentiation were predictors of a positive SL. On multivariable analysis, clinical T3/T4, signet ring cells, and poor differentiation independently predicted radiographically occult disease.

Conclusions

Hispanic patients presented with more locally advanced disease and were more likely to have occult disease found on SL compared with white patients. Laparoscopy should be used routinely as part of the pretreatment staging evaluation for patients with locally advanced disease as it alters the management in a significant proportion of patients.

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Acknowledgement

I.N. was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award No. UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.C.W is supported by the UTSW Disease-Oriented Clinical Scholarship. M.R.P. is a Dedman Family Scholar in Clinical Care. The authors thank Dave Primm for his help with editing this manuscript.

Disclosures

The authors have no commercial interests related to the subject of the study. I.N. was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105. S.C.W. is supported by the UTSW Disease-Oriented Clinical Scholarship. M.R.P. is a Dedman Family Scholar in clinical care.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Ibrahim Nassour MD, Adam C. Yopp MD, Mathew M. Augustine MD, PhD, Patricio M. Polanco MD, Michael A. Choti MD, MBA, John C. Mansour MD, Sam C. Wang MD & Matthew R. Porembka MD

  2. Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Hannah Fullington MPH & Linda S. Hynan PhD

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  1. Ibrahim Nassour MD
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Correspondence to Matthew R. Porembka MD.

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Nassour, I., Fullington, H., Hynan, L.S. et al. The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation. Ann Surg Oncol 24, 1787–1794 (2017). https://doi.org/10.1245/s10434-017-5805-7

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  • DOI: https://doi.org/10.1245/s10434-017-5805-7

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