Impact of Staging Laparoscopy on Treatment Intent in Non Metastatic Gastric Cancer: A Cross-sectional Study

Introduction: Stomach cancer remains a leading cause of cancer-related mortality worldwide, with a poor prognosis primarily due to late-stage diagnosis. Despite advances in imaging modalities, the sensitivity in detecting peritoneal metastases is limited. Diagnostic Laparoscopy/Surgical Laparoscopy (SL) is a minimally invasive tool that enables direct visualisation of intra-abdominal disease, thereby improving staging accuracy and guiding treatment decisions. Aim: To determine the proportion of patients with imagingdiagnosed non metastatic, resectable Gastric Cancer (GC) in whom SL alters the intended treatment plan. Materials and Methods: This retrospective cross-sectional observational study was conducted in the Departments of Surgical Oncology and Surgical Gastroenterology at Government Medical College, Kottayam, Kerala, India, from February 1, 2019, to February 28, 2025. Data were analysed in March 2025. The study was designed as a surgical audit to assess the utility of staging laparoscopy (SL) in patients with biopsy-proven, resectable gastric cancer without evidence of metastasis on imaging. Register-based data were collected regarding SL findings and any modifications made to the treatment plan based on the SL results. Data were analysed using descriptive statistics and the Chi-square test for associations; results were presented as frequencies, percentages, means±Standard Deviation (SD), Odds Ratios (OR), and p-values. Results: The mean age of the study participants was 59±9.76 years. Occult metastases were identified in 11 patients (40.7%); positive peritoneal cytology was present in 12 patients (44.4%). The presence of ascites was significantly associated with positive cytology (p=0.014), with an OR of 8. Furthermore, peritoneal deposits were present in 83.3% of cytology-positive cases, reinforcing the prognostic significance of SL. As a result, curative intent surgery was avoided in 11 (40.7%) of patients, redirecting them to palliative chemotherapy. No major complications were observed, and the mean hospital stay was one day. Conclusion: Gastric cancer has a propensity for early peritoneal dissemination that may be missed on routine imaging. Therefore, patients planned for curative-intent therapy should undergo diagnostic laparoscopy to detect occult peritoneal disease that may alter treatment intent. The present study highlights that a significant number of patients experience a change in their treatment plans when SL is performed at the start of treatment.