241 The Role of Staging Laparoscopy in Upper Gastrointestinal Cancers: A Comprehensive Analysis

Abstract Background Staging laparoscopy is an established tool for detecting occult peritoneal metastases in upper gastrointestinal (UGI) cancers. Its utility is well supported in gastric cancer; however, evidence for its role in oesophageal and gastro-oesophageal junction (GOJ) cancers is limited and largely predates the PET/CT era. Current guidelines vary in their recommendations. This study evaluates the diagnostic yield and clinical impact of staging laparoscopy across UGI cancer subtypes. Method A retrospective analysis was performed on 490 patients undergoing staging laparoscopy. After exclusions, 375 patients were included: oesophageal (n=136), GOJ (n=133), and gastric (n=106). The primary outcome was the incidence of positive peritoneal cytology by cancer subtype. Secondary outcomes included changes in treatment intent and procedural costs. Results Positive cytology was identified in 6.5% (24/369) overall: 12.0% in gastric, 6% in GOJ, and 2.9% in oesophageal cancers. Macroscopic peritoneal disease was seen in 10.5% (39/372), most commonly in gastric cancer. Staging laparoscopy influenced management in 13.6% (51/375), predominantly in gastric and GOJ S2/S3 cancers. The procedure had minimal impact in oesophageal cancer. It was well tolerated, with a median hospital stay of 1 day and mean cost of £2,373 (n=137). Conclusions Staging laparoscopy provides meaningful diagnostic and clinical value in gastric and select GOJ cancers, altering treatment in nearly 14% of cases. In contrast, its role in oesophageal cancer appears limited and of lower diagnostic utility, and minimal influence on management. A risk-adapted approach focusing on high-risk gastric and GOJ cases, while expediting time to treatment, and minimising healthcare costs for patients with oesophageal cancer.