Staging Laparoscopy in Gastric Cancer Patients Treated with Curative Intent: A European GASTRODATA Cohort Study

Background: In current guidelines, staging laparoscopy (SL) is recommended in patients with locally advanced gastric cancer (GC). This study aimed to assess the clinical practice of SL and its association with administration of systemic treatment in a European cohort of GC patients (GASTRODATA). Methods: In this retrospective cohort study, patients with locally advanced GC who underwent multimodal treatment in 24 European centers were analyzed. Patients with early (cT1) or metastatic GC at diagnosis and those with missing data on chemotherapy administration were excluded. Results: Of 2558 patients, 1726 were selected, with 562 (32.6%) undergoing SL. Patients who did not undergo SL were older (72 vs. 65 years; p < 0.001) and had higher Charlson Comorbidity Index scores (≥ 2: 33.8% vs. 20.5%; p < 0.001). These patients had more complications (30.9% vs. 24.4%; p = 0.005), higher 90-day mortality (4.7% vs. 2.3%; p = 0.017), and were less likely to receive neoadjuvant (35% vs. 78.6%; p < 0.001) or adjuvant (27.1% vs. 33.8%; p = 0.005) chemotherapy. Non-SL patients had higher rates of serosal invasion (pT4: 38.0% vs. 26.0%; p < 0.001) and lymph node metastasis (63.5% vs. 60.4%; p = 0.004). Conclusions: SL was performed in one-third of individuals with locally advanced GC. Absence of SL was associated with higher T-stage discrepancy and decreased utilization of multimodal treatment.