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Background <p>Imaging-invisible occult peritoneal metastasis (OPM) is not uncommon in patients with gastric or gastroesophageal junction adenocarcinoma (G/GEJC). This study aimed to identify the risk factors for OPM detected by laparoscopic exploration, characterize the dynamic changes in OPM on laparoscopic re-exploration after treatment, and evaluate their prognostic significance.</p> Methods <p>The study included 653 patients with newly diagnosed cT1−2N+/T3−4bNx, cM0 G/GEJC who underwent laparoscopic exploration and peritoneal lavage fluid cytology between July 2018 and June 2025. Of these 653 patients, 140 underwent repeat laparoscopy (the laparoscopic re-exploration cohort) with cytology after systemic therapy. Risk factors for OPM were identified by logistic regression and survival by Kaplan–Meier analysis.</p> Results <p>On initial laparoscopy, 22.2% (145/653) of the patients received a diagnosis of OPM+, whereas 77.8% (508/653) received a diagnosis of OPM−. Younger patients (age &lt; 35&#xa0;years), better Eastern Cooperative Oncology Group (ECOG) status (0 score), primary gastric cancers, CA72-4 (≥ 6.9&#xa0;U/mL), sT4a/b stage, and minimal ascites (vs no ascites) were associated with OPM+. Patients with OPM+ initially had significantly worse median overall survival than OPM− patients (15.9&#xa0;months vs not reached; <i>P</i> &lt; 0.001). In the laparoscopic re-exploration cohort, 26.4% (37/140) showed changes in OPM status. Specifically, among the initial OPM+ patients, 57.1% (16/28) were converted to OPM−, whereas 18.8% (21/112) of the initial OPM− patients were converted to OPM+. Persistent OPM− and conversion to OPM− were associated with better survival than persistent OPM+ and conversion to OPM+.</p> Conclusion <p>In locally advanced G/GEJC, OPM is common. Laparoscopic exploration is essential for detecting OPM, and dynamic laparoscopic evaluation of peritoneal metastasis status holds significant prognostic value.</p>

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The Clinical Value of Laparoscopic Exploration in Diagnosing and Dynamically Assessing Occult Peritoneal Metastasis in Gastric Cancer

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Xiao Yan,
  • Qing Xie,
  • Fengping Li,
  • Huayuan Liang,
  • Zhiwei Li,
  • Kaihua Huang,
  • Huimin Zhang,
  • Rou Zhong,
  • Min Lai,
  • Xinru Liu,
  • Jiang Yu,
  • Liying Zhao

摘要

Background

Imaging-invisible occult peritoneal metastasis (OPM) is not uncommon in patients with gastric or gastroesophageal junction adenocarcinoma (G/GEJC). This study aimed to identify the risk factors for OPM detected by laparoscopic exploration, characterize the dynamic changes in OPM on laparoscopic re-exploration after treatment, and evaluate their prognostic significance.

Methods

The study included 653 patients with newly diagnosed cT1−2N+/T3−4bNx, cM0 G/GEJC who underwent laparoscopic exploration and peritoneal lavage fluid cytology between July 2018 and June 2025. Of these 653 patients, 140 underwent repeat laparoscopy (the laparoscopic re-exploration cohort) with cytology after systemic therapy. Risk factors for OPM were identified by logistic regression and survival by Kaplan–Meier analysis.

Results

On initial laparoscopy, 22.2% (145/653) of the patients received a diagnosis of OPM+, whereas 77.8% (508/653) received a diagnosis of OPM−. Younger patients (age < 35 years), better Eastern Cooperative Oncology Group (ECOG) status (0 score), primary gastric cancers, CA72-4 (≥ 6.9 U/mL), sT4a/b stage, and minimal ascites (vs no ascites) were associated with OPM+. Patients with OPM+ initially had significantly worse median overall survival than OPM− patients (15.9 months vs not reached; P < 0.001). In the laparoscopic re-exploration cohort, 26.4% (37/140) showed changes in OPM status. Specifically, among the initial OPM+ patients, 57.1% (16/28) were converted to OPM−, whereas 18.8% (21/112) of the initial OPM− patients were converted to OPM+. Persistent OPM− and conversion to OPM− were associated with better survival than persistent OPM+ and conversion to OPM+.

Conclusion

In locally advanced G/GEJC, OPM is common. Laparoscopic exploration is essential for detecting OPM, and dynamic laparoscopic evaluation of peritoneal metastasis status holds significant prognostic value.