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.
  
  
  METHODS
  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.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. paul.karanicolas@sunnybrook.ca
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Jacks
authors.forename: Coral L
authors.initials: CL
authors.lastname: Atoria
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D018447:Medical Futility; D008498:Medical Record Linkage; D006278:Medicare; D009367:Neoplasm Staging; D018426:SEER Program; D013274:Stomach Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States