Staging laparoscopy in gastric cancer patients: From a Dutch nationwide Delphi consensus towards a standardized protocol

Karen van der Sluis; Niels A. D. Guchelaar; Lianne Triemstra; Ron H. J. Mathijssen; Jelle P. Ruurda; Bas P. L. Wijnhoven; Johanna W. van Sandick; M. I. van Berge Henegouwen; S. S. Gisbertz; W. J. Eshuis; F. Daams; W. A. Borstlap; M. D. P. Luyer; G. A. Simkens; G. A. P. Nieuwenhuizen; P. C. van der Sluis; S. M. Lagarde; B. J. Noordman; J. Heisterkamp; R. A. Matthijsen; E. P. C. Matthée; E. B. Wassenaar; E. G. J. M. Pierik; H. H. Hartgrink; W. O. de Steur; M. Hutteman; E. van der Harst; J. E. N. Pierie; M. Emous; W. Kelder; on behalf of the Collaborators

doi:10.1016/j.ejso.2024.108278

Staging laparoscopy in gastric cancer patients: From a Dutch nationwide Delphi consensus towards a standardized protocol

Karen van der Sluis, Niels A. D. Guchelaar, Lianne Triemstra, Ron H. J. Mathijssen, Jelle P. Ruurda, Bas P. L. Wijnhoven, Johanna W. van Sandick, M. I. van Berge Henegouwen, S. S. Gisbertz, W. J. Eshuis, F. Daams, W. A. Borstlap, M. D. P. Luyer, G. A. Simkens, G. A. P. Nieuwenhuizen, P. C. van der Sluis, S. M. Lagarde, B. J. Noordman, J. Heisterkamp, R. A. MatthijsenE. P. C. Matthée, E. B. Wassenaar, E. G. J. M. Pierik, H. H. Hartgrink, W. O. de Steur, M. Hutteman, E. van der Harst, J. E. N. Pierie, M. Emous, W. Kelder, on behalf of the Collaborators

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Staging laparoscopy is a common diagnostic tool in gastric cancer, but its performance varies widely. The aim of this study was to gain Dutch nationwide consensus regarding the indications for and execution of staging laparoscopy in patients with gastric cancer. Methods: All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants. Results: In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour's resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker's Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient. Conclusions: The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol.

Original language	English
Article number	108278
Journal	European Journal of Surgical Oncology
Volume	50
Issue number	6
DOIs	https://doi.org/10.1016/j.ejso.2024.108278
Publication status	Published - 1 Jun 2024

Keywords

Delphi study
Gastric cancer
Peritoneal cancer index
Peritoneal metastases
Staging laparoscopy

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10.1016/j.ejso.2024.108278

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van der Sluis, K., Guchelaar, N. A. D., Triemstra, L., Mathijssen, R. H. J., Ruurda, J. P., Wijnhoven, B. P. L., van Sandick, J. W., van Berge Henegouwen, M. I., Gisbertz, S. S., Eshuis, W. J., Daams, F., Borstlap, W. A., Luyer, M. D. P., Simkens, G. A., Nieuwenhuizen, G. A. P., van der Sluis, P. C., Lagarde, S. M., Noordman, B. J., Heisterkamp, J., ... on behalf of the Collaborators (2024). Staging laparoscopy in gastric cancer patients: From a Dutch nationwide Delphi consensus towards a standardized protocol. European Journal of Surgical Oncology, 50(6), Article 108278. https://doi.org/10.1016/j.ejso.2024.108278

@article{aecf9d125155455f9db2b0b9adf61969,

title = "Staging laparoscopy in gastric cancer patients: From a Dutch nationwide Delphi consensus towards a standardized protocol",

abstract = "Background: Staging laparoscopy is a common diagnostic tool in gastric cancer, but its performance varies widely. The aim of this study was to gain Dutch nationwide consensus regarding the indications for and execution of staging laparoscopy in patients with gastric cancer. Methods: All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants. Results: In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour's resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker's Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient. Conclusions: The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol.",

keywords = "Delphi study, Gastric cancer, Peritoneal cancer index, Peritoneal metastases, Staging laparoscopy",

author = "{van der Sluis}, Karen and Guchelaar, {Niels A. D.} and Lianne Triemstra and Mathijssen, {Ron H. J.} and Ruurda, {Jelle P.} and Wijnhoven, {Bas P. L.} and {van Sandick}, {Johanna W.} and {van Berge Henegouwen}, {M. I.} and Gisbertz, {S. S.} and Eshuis, {W. J.} and F. Daams and Borstlap, {W. A.} and Luyer, {M. D. P.} and Simkens, {G. A.} and Nieuwenhuizen, {G. A. P.} and {van der Sluis}, {P. C.} and Lagarde, {S. M.} and Noordman, {B. J.} and J. Heisterkamp and Matthijsen, {R. A.} and Matth{\'e}e, {E. P. C.} and Wassenaar, {E. B.} and Pierik, {E. G. J. M.} and Hartgrink, {H. H.} and {de Steur}, {W. O.} and M. Hutteman and {van der Harst}, E. and Pierie, {J. E. N.} and M. Emous and W. Kelder and {on behalf of the Collaborators} and Hartemink, {K. J.} and Veenhof, {A. A. F. A.} and N. Hugen and Klarenbeek, {B. R.} and {van Esser}, S. and Bilgen, {E. J. Spillenaar} and Witteman, {B. P. L.} and {van Etten}, B. and Dijkstra, {F. A.} and Haveman, {J. W.} and {van der Bilt}, A. and {van Hillegersberg}, R. and {van den Berg}, {J. W.} and Brenkman, {H. J. F.} and Kouwenhoven, {E. A.} and {van Det}, {M. J.} and Stoot, {J. H. M. B.} and Belgers, {E. H. J.} and Sosef, {M. N.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = jun,

day = "1",

doi = "10.1016/j.ejso.2024.108278",

language = "English",

volume = "50",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "6",

}

van der Sluis, K, Guchelaar, NAD, Triemstra, L, Mathijssen, RHJ, Ruurda, JP, Wijnhoven, BPL, van Sandick, JW, van Berge Henegouwen, MI , Gisbertz, SS , Eshuis, WJ , Daams, F , Borstlap, WA, Luyer, MDP, Simkens, GA, Nieuwenhuizen, GAP, van der Sluis, PC, Lagarde, SM, Noordman, BJ, Heisterkamp, J, Matthijsen, RA, Matthée, EPC, Wassenaar, EB, Pierik, EGJM, Hartgrink, HH, de Steur, WO, Hutteman, M, van der Harst, E, Pierie, JEN, Emous, M, Kelder, W & on behalf of the Collaborators 2024, 'Staging laparoscopy in gastric cancer patients: From a Dutch nationwide Delphi consensus towards a standardized protocol', European Journal of Surgical Oncology, vol. 50, no. 6, 108278. https://doi.org/10.1016/j.ejso.2024.108278

TY - JOUR

T1 - Staging laparoscopy in gastric cancer patients

T2 - From a Dutch nationwide Delphi consensus towards a standardized protocol

AU - van der Sluis, Karen

AU - Guchelaar, Niels A. D.

AU - Triemstra, Lianne

AU - Mathijssen, Ron H. J.

AU - Ruurda, Jelle P.

AU - Wijnhoven, Bas P. L.

AU - van Sandick, Johanna W.

AU - van Berge Henegouwen, M. I.

AU - Gisbertz, S. S.

AU - Eshuis, W. J.

AU - Daams, F.

AU - Borstlap, W. A.

AU - Luyer, M. D. P.

AU - Simkens, G. A.

AU - Nieuwenhuizen, G. A. P.

AU - van der Sluis, P. C.

AU - Lagarde, S. M.

AU - Noordman, B. J.

AU - Heisterkamp, J.

AU - Matthijsen, R. A.

AU - Matthée, E. P. C.

AU - Wassenaar, E. B.

AU - Pierik, E. G. J. M.

AU - Hartgrink, H. H.

AU - de Steur, W. O.

AU - Hutteman, M.

AU - van der Harst, E.

AU - Pierie, J. E. N.

AU - Emous, M.

AU - Kelder, W.

AU - on behalf of the Collaborators

AU - Hartemink, K. J.

AU - Veenhof, A. A. F. A.

AU - Hugen, N.

AU - Klarenbeek, B. R.

AU - van Esser, S.

AU - Bilgen, E. J. Spillenaar

AU - Witteman, B. P. L.

AU - van Etten, B.

AU - Dijkstra, F. A.

AU - Haveman, J. W.

AU - van der Bilt, A.

AU - van Hillegersberg, R.

AU - van den Berg, J. W.

AU - Brenkman, H. J. F.

AU - Kouwenhoven, E. A.

AU - van Det, M. J.

AU - Stoot, J. H. M. B.

AU - Belgers, E. H. J.

AU - Sosef, M. N.

PY - 2024/6/1

Y1 - 2024/6/1

N2 - Background: Staging laparoscopy is a common diagnostic tool in gastric cancer, but its performance varies widely. The aim of this study was to gain Dutch nationwide consensus regarding the indications for and execution of staging laparoscopy in patients with gastric cancer. Methods: All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants. Results: In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour's resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker's Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient. Conclusions: The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol.

AB - Background: Staging laparoscopy is a common diagnostic tool in gastric cancer, but its performance varies widely. The aim of this study was to gain Dutch nationwide consensus regarding the indications for and execution of staging laparoscopy in patients with gastric cancer. Methods: All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants. Results: In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour's resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker's Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient. Conclusions: The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol.

KW - Delphi study

KW - Gastric cancer

KW - Peritoneal cancer index

KW - Peritoneal metastases

KW - Staging laparoscopy

UR - http://www.scopus.com/inward/record.url?scp=85188785412&partnerID=8YFLogxK

U2 - 10.1016/j.ejso.2024.108278

DO - 10.1016/j.ejso.2024.108278

M3 - Article

C2 - 38531232

SN - 0748-7983

VL - 50

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 6

M1 - 108278

ER -

Staging laparoscopy in gastric cancer patients: From a Dutch nationwide Delphi consensus towards a standardized protocol

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Keywords

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