Diagnostic laparoscopy is underutilized in the staging of gastric adenocarcinoma regardless of hospital type: An US safety net collaborative analysis

• Type of Material: Article
• Authors: Aleeza Leder J Macek, NYU Langone Health; Annie Wang, NYU Langone Health; Michael K Turgeon, Emory University; Rachel M Lee, Emory University; Maria Russell, Emory University; Matthew R Porembka, University of Texas Southwestern Medical School; Rodrigo Alterio, University of Texas Southwestern Medical Schoolod; Michelle Ju, University of Miami; Joshua Kronenfeld, University of Miami; Neha Goel, University of Miami; Jashodeep Datta, University of Miami; Ajay Maker, University of Illinois at Chicago; Manuel Fernandez, University of Illinois at Chicago; Harry Richter, John H. Stroger Jr. Hospital of Cook County; Russell S Berman, NYU Langone Health, New York; Camilo Correa-Gallego, NYU Langone Health, New York; Ann Y Lee, NYU Langone Health, New York
• Language: English
• Date: 2022-06-14
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Wiley Periodicals LLC.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.26972
• Title of Journal or Parent Work: JOURNAL OF SURGICAL ONCOLOGY
• Volume: 126
• Issue: 4
• Start Page: 649
• End Page: 657
• Keywords: safety net hospital; Oncology; diagnostic laparoscopy; disparities; RISK; CANCER; Life Sciences & Biomedicine; Science & Technology; gastric adenocarcinoma; HELICOBACTER-PYLORI; Surgery; MANAGEMENT

Abstract

Background: Diagnostic laparoscopy (DL) is a key component of staging for locally advanced gastric adenocarcinoma (GA). We hypothesized that utilization of DL varied between safety net (SNH) and affiliated tertiary referral centers (TRCs). Methods: Patients diagnosed with primary GA eligible for DL were identified from the US Safety Net Collaborative database (2012–2014). Clinicopathologic factors were analyzed for association with use of DL and findings on DL. Overall survival (OS) was analyzed by Kaplan–Meier method. Results: Among 233 eligible patients, 69 (30%) received DL, of which 24 (35%) were positive for metastatic disease. Forty percent of eligible SNH patients underwent DL compared to 21.5% at TRCs. Lack of insurance was significantly associated with decreased use of DL (OR 0.48, p < 0.01), while African American (OR 6.87, p = 0.02) and Asian race (OR 3.12, p ≤ 0.01), signet ring cells on biopsy (OR 3.14, p < 0.01), and distal tumors (OR 1.62, p < 0.01) were associated with increased use. Median OS of patients with a negative DL was better than those without DL or a positive DL (not reached vs. 32 vs. 12 months, p < 0.005, Figure 1). Conclusions: Results from DL are a strong predictor of OS in GA; however, the procedure is underutilized. Patients from racial minority groups were more likely to undergo DL, which likely accounts for higher DL rates among SNH patients.