title: Staging Laparoscopy for Patients with cM0, Type 4, and Large Type 3 Gastric Cancer.
abstract: BACKGROUND
  Staging laparoscopy (SL) is considered useful for detecting peritoneal metastasis, a task that is difficult using conventional imaging modalities. However, indications for the procedure remain unclear, with differences evident across reports. The present study aimed to clarify the effectiveness and limitations of SL for patients with type 4 and large type 3 gastric cancer.
  
  
  METHODS
  We included 88 patients with cM0, type 4 or large type 3 gastric cancer who underwent SL at the Shizuoka Cancer Center from August 2008 to June 2014, to determine the detection rate of peritoneal metastasis by SL. In addition, we calculated the false-negative rate of SL by recruiting patients who were diagnosed as P0 at SL and underwent laparotomy within 28 days after the SL.
  
  
  RESULTS
  P0CY0, P0CY1, P1CY0, and P1CY1 were diagnosed in 41 (46.6 %), 15 (17.0 %), 15 (17.0 %), and 17 (19.3 %) patients, respectively. Accordingly, clinically non-evident peritoneal metastasis was found in 36.3 % of patients, and 53.4 % of patients were diagnosed with stage IV. In addition, 29 patients diagnosed as P0 at SL underwent laparotomy within 28 days after the SL. Among them, peritoneal metastasis was found in five patients. Thus, the false-negative rate was 17.2 % (5/29, 95 % CI 7.6-34.6 %).
  
  
  CONCLUSIONS
  SL is useful for detecting previously unsuspected peritoneal metastasis and for avoiding unnecessary laparotomy, although the high false-negative rate cannot be ignored. Patients with cM0, type 4, and large type 3 gastric cancer are considered suitable candidates for SL.
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumicho, Suntogun, Shizuoka, 411-8777, Japan. u16miki@icloud.com.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Miki
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumicho, Suntogun, Shizuoka, 411-8777, Japan. m.tokunaga@scchr.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumicho, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumicho, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Bando
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumicho, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumicho, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery