Abstract：
BACKGROUND: Staging laparoscopy is a common diagnostic tool in gastric cancer, but its performance varies widely. The aim of this study was to gain Dutch nationwide consensus regarding the indications for and execution of staging laparoscopy in patients with gastric cancer.
METHODS: All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants.
RESULTS: In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour\'s resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker\'s Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient.
CONCLUSIONS: The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol.
METHODS: All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants.
RESULTS: In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour\'s resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker\'s Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient.
CONCLUSIONS: The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol.
摘要：
背景：分期腹腔镜检查是胃癌的常见诊断工具，但其性能差异很大。这项研究的目的是在荷兰全国范围内就胃癌患者进行分期腹腔镜检查的适应症和执行情况达成共识。
方法：荷兰所有从事胃癌手术的外科医生（n=52）被要求参加Delphi共识研究。该研究涉及带有3分Likert量表的初始问卷，网上共识会议,和第二份问卷使用2点李克特量表(同意/不同意)。共识被定义为参与者之间70％或更多的共识。
结果：总计，45名专家完成了两份问卷（87%的回复率）。对cT3-4或cN+或弥漫型胃癌进行分期腹腔镜检查的指征达成共识，包括SiewertIII型食管胃交界性癌。专家们一致认为，如果术前扫描显示周围器官浸润（cT4），应明确研究肿瘤的可切除性。根据Sugarbaker的腹膜癌指数（PCI）评分，系统腹膜腔检查也达成共识。所有地区都应定期检查，尽管可以根据指示检查网膜囊。应进行腹水抽吸或腹膜冲洗以进行细胞学检查。专家们一致认为，在术前影像学上进行性疾病的情况下，应在切除前进行腹腔镜检查。没有进步,全球检查被认为是足够的。
结论：这项荷兰全国性德尔菲共识研究的结果揭示了胃癌患者进行分期腹腔镜检查的可变性，并为标准化方案提供了概念。
方法：荷兰所有从事胃癌手术的外科医生（n=52）被要求参加Delphi共识研究。该研究涉及带有3分Likert量表的初始问卷，网上共识会议,和第二份问卷使用2点李克特量表(同意/不同意)。共识被定义为参与者之间70％或更多的共识。
结果：总计，45名专家完成了两份问卷（87%的回复率）。对cT3-4或cN+或弥漫型胃癌进行分期腹腔镜检查的指征达成共识，包括SiewertIII型食管胃交界性癌。专家们一致认为，如果术前扫描显示周围器官浸润（cT4），应明确研究肿瘤的可切除性。根据Sugarbaker的腹膜癌指数（PCI）评分，系统腹膜腔检查也达成共识。所有地区都应定期检查，尽管可以根据指示检查网膜囊。应进行腹水抽吸或腹膜冲洗以进行细胞学检查。专家们一致认为，在术前影像学上进行性疾病的情况下，应在切除前进行腹腔镜检查。没有进步,全球检查被认为是足够的。
结论：这项荷兰全国性德尔菲共识研究的结果揭示了胃癌患者进行分期腹腔镜检查的可变性，并为标准化方案提供了概念。
