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Abstract
Peritoneal carcinomatosis (PC) is a leading cause of gastric carcinoma unrespectability and is frequently undetected with conventional imaging. Diagnostic laparoscopy (DL) enables direct examinations, cytological evaluation, staging precision, and eliminates non-therapeutic laparotomy. The purpose of this study was to determine the percentage of gastric carcinoma cases with PC identified on DL and investigate clinical and pathological predictors of positive DL results. This cross-sectional observational study involved 65 patients with histologically verified gastric carcinoma who received DL. Patients were classified as DL-positive (macroscopic peritoneal deposits present and/or positive peritoneal cytology, n = 40) and DL-negative (n = 25). Demographic, clinical, and tumor-related characteristics were analyzed in groups. The chi-square and independent t-tests were used to conduct statistical analysis, and odds ratios (OR) and 95% confidence intervals (CI) were calculated for the univariate predictors. A p-value <0.05 was considered significant. Among 65 patients, 40 (61.5%) were DL-positive PC. Of these, 18 (45.0%) had macroscopic peritoneal metastases, 20 (50.0%) had positive cytology only, and 8 (20.0%) had both. 2 (5.0%) had an unresectable primary tumor without PC. Negative DL was observed in 25 patients (38.5%). The important predictors of PC were diffuse histology, 25 (62.5%) in positive DL vs. 9 (36.0%) in negative DL, advanced tumor (T) stage, T3-T4: 34 (85.0%) in positive DL vs. 15 (60.0%) in negative, p=0.027, and nodal (N) status, N2-N3: 27 (67.5%) in positive DL group vs. 12 (48.0%) in negative DL group. Additional risks were linked to rural residence and low basal metabolic index (BMI). About one out of four patients with gastric carcinoma had PC that was only visible with DL. Diffuse histology (p = 0.027), advanced T stage (p = 0.027), and higher age (p = 0.001) were significant predictors of PC. Higher nodal stage, rural residence, and lower BMI showed strong associations, with p-values approaching significance. Incorporating DL should be regarded as a vital staging modality in advanced gastric carcinoma.
References
1. Mamun TI, Younus S, Rahman MH. Gastric cancer-Epidemiology, modifiable and non-modifiable risk factors, challenges and opportunities: An updated review. Cancer Treat Res Commun. 2024;41:100845.
2. Guan G, Li Z, Wang Q, Ying X, Shan F, Li Z. Risk factors associated with peritoneal carcinomatosis of gastric cancer in staging laparoscopy: A systematic review and meta-analysis. Front Oncol. 2022;12:955181.
3. Fu C, Zhang B, Guo T, Li J. Imaging Evaluation of Peritoneal Metastasis: Current and Promising Techniques. Korean J Radiol. 2024;25(1):86-102.
4. Li Z, Guan G, Liu Z, Li J, Ying X, Shan F, Li Z. Predicting peritoneal carcinomatosis of gastric cancer: A simple model to exempt low-risk patients from unnecessary staging laparoscopy. Front Surg. 2022;9:916001.
5. van Hootegem SJM, Chmelo J, van der Sluis PC, Lagarde SM, Phillips AW, Wijnhoven BPL. The yield of diagnostic laparoscopy with peritoneal lavage in gastric adenocarcinoma: A retrospective cohort study. Eur J Surg Oncol. 2024;50(4):108233.
6. Cortés-Guiral D, Hübner M, Alyami M, Bhatt A, Ceelen W, Glehen O, Lordick F, Ramsay R, Sgarbura O, Van Der Speeten K, Turaga KK, Chand M. Primary and metastatic peritoneal surface malignancies. Nat Rev Dis Primers. 2021;7(1):91.
7. De Ruvo N, Fenocchi S, Veronesi L, Missori G, Ricciardolo AA, Rossi EG, Sorrentino L, Cautero N, Serra F, Gelmini R. Prognostic factors in gastric cancer patients: a 10-year mono-institutional experience. Front Surg. 2024;11:1321981.
8. Liu K, Cui L, Li C, Tang C, Niu Y, Hao J, Bu Y, Chen B. Pan-cancer analysis of the prognostic and immunological role of ANLN: An onco-immunological biomarker. Front Genet. 2022;13:922472.
9. Repiso A, Gómez-Rodríguez R, López-Pardo R, Lombera MM, Romero M, Aranzana A, Abad S, Rodríguez-Merlo R, López L, Carboles JM. Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact. Rev Esp Enferm Dig. 2010;102(7):413-20.
10. Rawicz-Pruszyński K, Erodotou M, Pelc Z, Sędłak K, Polkowski W, Pawlik TM, Wijnhoven BPL. Techniques of staging laparoscopy and peritoneal fluid assessment in gastric cancer: a systematic review. Int J Surg. 2023;109(11):3578-3589.
11. Butensky SD, Bansal VV, Su DG, Waheed MT, Nikiforchin A, Gomez-Mayorga JL, Olecki E, Radomski SN, Sun B, Turaga KK, Gunderson CG, Lacy J, Badgwell BD, In H, Kennedy T, Yoon HH, Greer JB, Sundar R, Woo Y; Peritoneal Surface Malignancies Consortium Group. Consensus guideline for the management of gastric cancer with synchronous peritoneal metastases. Cancer. 2025;131(13):e35870.
12. Gęca K, Skórzewska M, Rawicz-Pruszyński K, Mlak R, Sędłak K, Pelc Z, Małecka-Massalska T, Polkowski WP. Prognostic value of molecular cytology by one-step nucleic acid amplification (OSNA) assay of peritoneal washings in advanced gastric cancer patients. Sci Rep. 2022;12(1):12477.
13. O'Leary L, Botzenhardt E, Gilbert TM, Quinn LM, Díaz-Nieto R, Jones RP, Jones L, Griffin M, Stanley R, Leppert A, Malik HZ, Fenwick SW. Update to the role of staging laparoscopy in the assessment of resectability of perihilar cholangiocarcinoma: have improvements in cross-sectional and functional imaging rendered it redundant? HPB (Oxford). 2025;27(8):1113-1123.
14. Sun BJ, Lee B. Review of Regional Therapies for Gastric Cancer with Peritoneal Metastases. Cancers (Basel). 2022;14(3):570.
15. Zulfania Z, Hayat H, Mahmood R, Bukhari AA, Ihtesham Y, Rasool U. Comparison of platelet indices in hypoproductive and hyperdestructive thrombocytopenia. Pakistan Journal of Physiology. 2021;17(2):3-6.
16. Parveen N, Bukhari AA, Khan Z, Mahmood R, Khan K, Ihtesham Y. Association of diabetic retinopathy with dyslipidemia: a multicenter study. J Rehman Med Inst. 2018;4(4):21-24.
17. Bukhari AA, Parveen N, Khan Q, Khan K. Leptin levels in vitreous fluids of patients with diabetic retinopathy. Journal of Rehman Medical Institute. 2015;1(1):17-20.
18. Parveen N, Khan Z, Mahmood R, Bukhari AA, Khan K, Khan Q, Rasool U. Serum and vitreous levels of Interleukin-6, Leptin and Vascular Endothelial Growth Factor in patients with proliferative and non-proliferative diabetic retinopathy. Journal of Rehman Medical Institute. 2018;4(3):08-10.
19. Ullah I, Bukhari AA, Durrani M, Khan Z, Tauqir S, Farid B, Khan MF. Risk factors for ventricular tachycardia in acute ST-elevated myocardial infarction patients of a tertiary care hospital of Peshawar. Journal of Rehman Medical Institute. 2020;6(4):12-5.
20. Zhang Y, Ilyas M, Yilin W, Su Y, Bukhari AA, Ahmad A. A Methodical Approach to Scrutinize the Role of Body Mass Index in Heart Rate Increment and Recovery. Journal of Gandhara Medical & Dental Sciences (JGMDS). 2022;9(4):31-6.
21. Bukhari AA, Durrani M, Khan Z, Shafiq M, Tauqir S, ur Rehman A. Urinary excretion of electrolytes and their correlation with clinical parameters in chronic kidney disease. Journal of Rehman Medical Institute. 2020;6(2):08-11.
22. Bukhari AA, Parveen N, Khan Q, Khan K. Levels of serum interleukin il-6 in patients with advanced diabetic retinopathy. Journal of Rehman Medical Institute. 2015;1(1):4-8.
23. Rasool U, Ihtesham Y, Bukhari AA, Khan Z. Common presentations of non-traumatic acute abdomen on Ultrasound in patients presenting to the Emergency Department of Hayatabad Medical Complex, Peshawar. Journal of Rehman Medical Institute. 2019;4(4):12-15.
24. Rehman S, Durrani M, Bukhari AA, Tariq K, Rehman AU, Shafiq M. Can BNP levels and Killip grading assess the severity of injury to myocardium after acute myocardial infarction in Type II Diabetics?. Journal of Rehman Medical Institute. 2021;4(3):03-7.
25. Chen ZD, Zhang PF, Xi HQ, Wei B, Chen L, Tang Y. Recent Advances in the Diagnosis, Staging, Treatment, and Prognosis of Advanced Gastric Cancer: A Literature Review. Front Med (Lausanne). 2021;8:744839.
26. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.
27. Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024;13(7):2555-2561.
28. Sun H, Zhao A, Li M, Dong H, Sun Y, Zhang X, Zhu Q, Bukhari AA, Cao C, Su D, Liu Y, Liang X. Interaction of calcium binding protein S100A16 with myosin-9 promotes cytoskeleton reorganization in renal tubulointerstitial fibrosis. Cell Death Dis. 2020;11(2):146.
29. Bukhari AA, Shaikh AR, Salman W, Bhatti FA, Malik W, Minhas M, Muddasser A, Khaliq H. Pathophysiological role of nerve growth factor (NGF) in asthma: insights into airway inflammation, remodeling, and neural regulation in intensive care settings. Anaesth. pain intensive care. 2025;29(3):681-689.
30. Gong J, Ali N, Abubakar M, Bukhari AA, Ilyas M, Bashir U, Ali M, Zaman MH. The predominant role of cd4+t cell-derived small extracellular vesicles in immune enhancement. Journal of Population Therapeutics and Clinical Pharmacology. 2023:30(18):1774-1783.
31. Ho SYA, Tay KV. Systematic review of diagnostic tools for peritoneal metastasis in gastric cancer-staging laparoscopy and its alternatives. World J Gastrointest Surg. 2023;15(10):2280-2293.
32. Tahira S, Bibi F, Niaz M, Bukhari AA, Butt AI, Khan E. Multi-organ pathophysiology of endometriosis: Evaluating neurotrophin linked multifaceted health risks assessments. Official Journal of Pakistan Medical Association, Rawalpindi–Islamabad Rawalpindi–Islamabad. 2025;50(2):377.
33. Schena CA, Laterza V, De Sio D, Quero G, Fiorillo C, Gunawardena G, Strippoli A, Tondolo V, de'Angelis N, Alfieri S, Rosa F. The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives. Cancers (Basel). 2023;15(13):3425.
34. Jiang Y, Liang X, Wang W, Chen C, Yuan Q, Zhang X, Li N, Chen H, Yu J, Xie Y, Xu Y, Zhou Z, Li G, Li R. Noninvasive Prediction of Occult Peritoneal Metastasis in Gastric Cancer Using Deep Learning. JAMA Netw Open. 2021;4(1):e2032269.
35. Z HM, Tahir S, Ali N, Bukhari AA, Zeb F, Khalid M, Salim F, Raja AA. Effect of qrs duration on cardiac resynchronization therapy in patients with heart failure and its related factors. Journal of Population Therapeutics and Clinical Pharmacology. 2023;30(18):638-649.
36. Kubo N, Cho H, Lee D, Yang H, Kim Y, Khalayleh H, Yoon HM, Ryu KW, Hanna GB, Coit DG, Hakamada K, Kim YW Professor. Risk prediction model of peritoneal seeding in advanced gastric cancer: A decision tool for diagnostic laparoscopy. Eur J Surg Oncol. 2023;49(4):853-861.
37. Orakzai S, Ijaz A, Bukhari AA, Durrani M. Evaluation of Random Plasma Glucose with Lowered Cutoff Limits for Screening of Diabetes and Prediabetes. Pakistan Journal of Medical & Health Sciences. 2022;16(07):321-321.
38. Solaini L, Bencivenga M, D'ignazio A, Milone M, Marino E, De Pascale S, Rosa F, Sacco M, Fumagalli Romario U, Graziosi L, De Palma G, Marrelli D, Morgagni P, Ercolani G. Which gastric cancer patients could benefit from staging laparoscopy? A GIRCG multicenter cohort study. Eur J Surg Oncol. 2022;48(8):1778-1784.
39. Durrani M, Bukhari AA, Abubakr M, Zaman MH, Khan F, Nasim S. The effect of low zinc on the fabrication of short chain fatty acids by colonic microbiota in infants. Grasas y aceites. 2022;16:2.
40. Rieser CJ, Hoehn RS, Zenati M, Hall LB, Kang E, Zureikat AH, Lee A, Ongchin M, Holtzman MP, Pingpank JF, Bartlett DL, Choudry MHA. Impact of Socioeconomic Status on Presentation and Outcomes in Colorectal Peritoneal Metastases Following Cytoreduction and Chemoperfusion: Persistent Inequalities in Outcomes at a High-Volume Center. Ann Surg Oncol. 2021;28(7):3522-3531.
41. Kausar R, Batool A, Bukhari AA, Shaikh AR, Aleem A, Minhas M, Hussain M. Crosslinking Salivary Diagnosis with Non-Invasive Insights to Oral Pathology: Novel Systematic Insights to Personalized Medicine in Disease Management. . Pak Armed Forces Med J. 2025;75(3):611-616.
42. Ghaffar T, Ahmad I, Bukhari AA. Effect of the timing of thyroxine intake on thyroid stimulating hormone levels in Ramadan. PJMHS. 2021;15(01):46-8.
43. Bukhari AA, Tauqir S, Tariq MM, Wadood U, Mahmood R, Zaman MH. Stress vulnerability in Medical Health Care Professionals of Pakistan during the COVID-19 pandemic. Al-Qanṭara. 2022;8(2).
44. Ofluoğlu CB, Aydın IC, Mülküt F, Uzun O, Senger AS, Gülmez S, et al. Diagnostic Efficacy of Staging Laparoscopy Compared to CT and PET-CT in Gastric Cancer: A Retrospective Cohort Analysis. Medicina (Kaunas). 2024;60(12):2079.
45. Durrani M, Bukhari AA, Abubakr M, Tariq K, Rehman AU, Shafiq M. Effects of feeding practices on the diversity of faecal short chain Fatty acids in 1-4 months infants in Pakistani cohort. Rehman Journal of Health Sciences. 2020;2(2):36-9.
46. Bausys A, Ümarik T, Dobrzhanskyi O, Luksta M, Kondratskyi Y, Reinsoo A, Vassiljev M, Bausys B, Bickaite K, Rauduvyte K, Luksaite-Lukste R, Bausys R, Strupas K. Neoadjuvant Chemotherapy Followed by Gastrectomy for Cytology-Positive Gastric Cancer without Any Other Non-Curative Factors in a Western Setting: An International Eastern European Cohort Study. Cancers (Basel). 2023;15(24):5794.
47. Chen H, Gou L, Fang Z, Dou Q, Chen H, Chen C, Qiu Y, Zhang J, Ning C, Hu Y, Deng H, Yu J, Li G. Artificial intelligence assisted real-time recognition of intra-abdominal metastasis during laparoscopic gastric cancer surgery. npj Digital Medicine. 2025;8(1):9.
48. Zhu ZN, Feng QX, Li Q, Xu WY, Liu XS. Machine learning-based CT radiomics approach for predicting occult peritoneal metastasis in advanced gastric cancer preoperatively. Clin Radiol. 2025;80:106727.
49. Wadood U, Sultana U. Effectiveness of Triamcinolone Acetonide Ointment and Bovine Basic Fibroblast Growth Factor in the Treatment of Minor Recurrent Aphthous Ulcer. PJMHS. 2020;14(3):780-82.
50. Zhang X, Li M, Zhao A, Dong H, Liang X. Cofilin participates in regulating alpha-epithelial sodium channel by interaction with 14-3-3 isoforms. J Biomed Res. 2020;34(5):351–360.
51. Zhu Q, Dong H, Bukhari AA, Zhao A, Li M, Sun Y, Zhang X, Cao C, Su D, Liang X. HUWE1 promotes EGFR ubiquitination and degradation to protect against renal tubulointerstitial fibrosis. The FASEB Journal. 2020;34(3):4591-601.
52. Ali A, Bukhari AA, Majeed S, Gul S, Khalil N, Wadood U. Frequency of Hypocalcemia with Exchange Transfusion in Neonatal Jaundice. PJMHS. 2021;15(8):1849-54.
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