title: The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation.
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.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Nassour
authors.affiliation: Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Fullington
authors.affiliation: Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Yopp
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Mathew M
authors.initials: MM
authors.lastname: Augustine
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Patricio M
authors.initials: PM
authors.lastname: Polanco
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Mansour
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Sam C
authors.initials: SC
authors.lastname: Wang
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA. matthew.porembka@utsouthwestern.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Porembka
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology* / Q000473:pathology / Q000601:surgery; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000208:ethnology* / Q000473:pathology / Q000601:surgery; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D044469:Racial Groups; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000601:surgery; D044465:White People / Q000706:statistics & numerical data