Clinical Significance Of Laparoscopic Exploration Combined With Abdominal Exfoliative Cytology In The Diagnosis And Treatment Of Locally Advanced Gastric Cancer

Objective:To explore the clinical significance of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of patients with locally advanced gastric cancer.Methods:The clinical data of 225 patients with locally advanced gastric cancer who underwent laparoscopic exploration combined with abdominal exfoliative cytology in a prospective,multicenter,open-label,randomized controlled phase III clinical trial（NCT01516944）were collected.The results of laparoscopic exploration were analyzed.Program selection and prognosis.Results:1.Among the 225 patients,there were 45 cases in the second stage of preoperative clinical stage and 180 cases in stage III.68 cases（30.22%）were found to be biased in clinical stage by laparoscopic exploration,and 7 cases（3.11%）decreased in stage,and 61 cases increased.（27.11%）.All patients were corrected by laparoscopic exploration and found 39 cases in stage II,118cases in stage III,and 61 cases in stage IV.Among the patients with stage IV,29（12.89%）had peritoneal metastasis and 32（14.22%）had free cancer cells in the abdominal cavity.2.Of the 225 patients,126（56.00%）underwent a D2 radical surgery after laparoscopic exploration.38 patients（16.89%）were found to have local neoplasia and later switched to neoadjuvant chemotherapy.In 29 patients with peritoneal metastases,2 patients underwent D2 radical surgery for peritoneal metastasis in the second laparoscopic exploration.In 32 patients with positive peritoneal cytology,7 patients underwent double laparoscopic exploration without D2 radical surgery.3.The overall 2-year survival rate of 225 patients was 64.00%.The first laparoscopic exploration found 164 patients with P₀CY₀,the 2-year overall survival rate was 70.73%;32 patients with P₀CY₁,the 2-year overall survival rate was 65.62%;There were 29 P₁CY_0/1/1 patients,and the 2-year overall survival rate was 24.14%.There was a significant difference between the three（P<0.05）.Hierarchical analysis found that 180 patients with stage III preoperative laparoscopic examination found 125 cases of P₀CY₀,28 cases of P₀CY₁,and 27 cases of P₁CY_0/1.The two-year overall survival rate was significantly different（P<0.05）.Conclusion:1.Laparoscopic exploration combined with abdominal exfoliative cytology can correct the bias in the local advanced gastric TNM staging,and can be used as a supplement in addition to traditional imaging CT staging.2.Laparoscopic exploration combined with peritoneal exfoliative cytology in patients with locally advanced gastric cancer has important clinical guiding significance for the discovery of peritoneal metastasis and intra-abdominal occult metastasis,and the selection of various treatment options and prognosis.Sexual open-close abdominal surgery.