Abstract
OBJECTIVES: The study objectives were to determine whether diagnostic laparoscopy improves staging accuracy in selected patients with distal esophageal adenocarcinoma and to identify clinicopathologic features associated with positive diagnostic laparoscopy. METHODS: Patients with distal esophageal adenocarcinoma who underwent diagnostic laparoscopy from 2000 to 2023 at a single institution were identified from a prospectively maintained surgical database. Exclusion criteria included performance of diagnostic laparoscopy after systemic therapy, absence of staging positron computed tomography/computed tomography, and M1 disease before diagnostic laparoscopy. Fisher exact test and Wilcoxon rank-sum test were used to compare categorical and continuous variables, respectively, between patients with negative and positive diagnostic laparoscopy. Clinicopathologic features were assessed using multivariable logistic regression. RESULTS: In total, 226 of 2131 patients with distal esophageal adenocarcinoma (11%) underwent diagnostic laparoscopy; 93% of these patients (211/226) had clinical T stage 3 or more. Most patients had clinical stage III disease before diagnostic laparoscopy (205/226 [91%]). In total, 183 patients (81%) had negative diagnostic laparoscopy, and 43 patients (19%) had positive diagnostic laparoscopy. In 40 patients (20%), disease was upstaged from III to IVB after positive diagnostic laparoscopy. Distal esophageal adenocarcinoma with signet ring feature (odds ratio, 2.45, 95% CI, 1.05-5.86; P = .040) was associated with positive diagnostic laparoscopy. Cardia involvement (P = .581), clinical T stage (P > .999), presence of clinical nodal disease (P = .550), clinical stage before diagnostic laparoscopy (P > .999), maximum standardized uptake value (P = .124), and poor differentiation without signet ring feature (P = .341) were not associated with positive diagnostic laparoscopy. CONCLUSIONS: Signet ring feature is associated with peritoneal disease. The use of diagnostic laparoscopy in these patients may lead to better staging and more appropriate treatment strategies.