Background and Aims: Gastric cancer (GC) remains a leading cause of cancer-related mortality, frequently diagnosed at advanced stages. High-risk features—tumor size ≥ 40 mm, cT3/cT4, nodal involvement, diffuse histology, and Borrmann type III/IV—are associated with peritoneal metastasis (PM). Staging laparoscopy with peritoneal washing (PW) is superior to conventional preoperative imaging modalities, including contrast-enhanced CT, MRI, PET/CT and endoscopic ultrasound, in detecting occult peritoneal disease. In this era of personalized medicine and expanding loco-regional strategies such as cytoreductive surgery (CRS)/Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC), accurate staging is crucial. This study assessed the impact of SL and PW in high-risk GC. Methods: We retrospectively analyzed 113 consecutive high-risk GC patients who underwent SL and PW between 2014 and 2024 at our institution. The primary endpoint was detection of PM or positive cytology (CY+). Secondary endpoints were treatment modification, eligibility for loco-regional therapy, and safety. Results: SL/PW identified PM or CY+ in 26 patients (23%), including 16 with CY+ only. None had radiologic signs of peritoneal disease. SL findings altered treatment in all cases: 21 patients (81%) with Peritoneal Cancer Index (PCI) < 6 underwent induction chemotherapy followed by CRS + HIPEC; 5 patients (PCI > 6) were spared non-therapeutic laparotomy and treated with bidirectional systemic chemotherapy and PIPAC. In 10 patients, systemic therapy was shifted from FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) to FOLFOX (fluorouracil, leucovorin, and oxaliplatin) ± nivolumab. No perioperative complications occurred; all patients were discharged within 24 h without delay in systemic treatment. Conclusions: SL with PW is safe and significantly improves staging accuracy in high-risk GC, enabling personalized therapeutic planning. Routine integration of SL should be considered essential in treatment algorithms to guide systemic and loco-regional strategies.
**背景与目的：** 胃癌仍是癌症相关死亡的主要原因，常于晚期确诊。高危特征——肿瘤大小≥40毫米、cT3/cT4分期、淋巴结受累、弥漫型组织学以及Borrmann III/IV型——与腹膜转移相关。在检测隐匿性腹膜疾病方面，诊断性腹腔镜联合腹腔灌洗细胞学检查优于传统的术前影像学检查方法，包括增强CT、MRI、PET/CT和超声内镜。在个体化医疗时代，随着细胞减灭术联合腹腔热灌注化疗以及加压腹腔内气溶胶化疗等局部区域治疗策略的扩展，精准分期至关重要。本研究评估了诊断性腹腔镜联合腹腔灌洗细胞学检查在高危胃癌患者中的应用价值。 **方法：** 我们回顾性分析了2014年至2024年间在我院连续接受诊断性腹腔镜联合腹腔灌洗细胞学检查的113例高危胃癌患者。主要终点是腹膜转移或细胞学阳性的检出率。次要终点包括治疗方案的调整、接受局部区域治疗的资格以及安全性。 **结果：** 诊断性腹腔镜联合腹腔灌洗细胞学检查在26例患者中检出腹膜转移或细胞学阳性，检出率为23%，其中16例仅为细胞学阳性。所有患者均无影像学腹膜转移征象。腹腔镜发现改变了所有病例的治疗方案：21例腹膜癌指数<6的患者接受了诱导化疗，随后行细胞减灭术联合腹腔热灌注化疗；5例腹膜癌指数>6的患者避免了非治疗性剖腹探查，接受了双向全身化疗联合加压腹腔内气溶胶化疗。10例患者的全身治疗方案从FLOT方案改为FOLFOX方案±纳武利尤单抗。无围手术期并发症发生；所有患者均在24小时内出院，全身治疗未受影响。 **结论：** 诊断性腹腔镜联合腹腔灌洗细胞学检查安全，并能显著提高高危胃癌的分期准确性，有助于制定个体化治疗计划。在治疗流程中常规整合诊断性腹腔镜应被视为指导全身及局部区域治疗策略的关键环节。
肿瘤(癌症)患者之家