The role of routine staging laparoscopy for esophagogastric cancer: a single-center experience

INTRODUCTION Appropriate staging is a critical step in the management of esophagogastric adenocarcinoma (AC), as the presence of occult metastatic disease, has a decisive impact on treatment strategy and prognosis. Despite advances in conventional radiological imaging, small-volume peritoneal involvement frequently remains undetected, potentially leading to inaccurate staging and non-beneficial surgical interventions. In this context, staging laparoscopy (SL) has been proposed as an adjunctive tool to improve staging accuracy, and in particular the evaluation of peritoneal involvement. AIM OF THE STUDY The aim of this study was to evaluate the role of SL in improving staging accuracy in esophagogastric AC, with a focus on its ability to detect occult metastatic disease and to evaluate the actual extent of disease. MATERIALS AND METHODS This was a single-center retrospective observational study conducted on a prospectively maintained database. Patients with histologically confirmed AC of the distal esophagus, gastroesophageal junction (GEJ), or stomach who underwent SL between July 2020 and December 2025 were included. Preoperative staging consisted of endoscopy and contrast-enhanced computed tomography (CT), with additional imaging modalities performed in selected cases. SL included systematic exploration of the peritoneal cavity, assessment of the Peritoneal Cancer Index (PCI), peritoneal biopsies, and peritoneal washing (PW) for cytological examination. Concordance between preoperative and laparoscopic T and M staging, as well as rates of staging modification, were analyzed. RESULTS A total of 147 patients were included. SL identified occult metastatic disease in 14.5% of patients, leading to clinically relevant upstaging, particularly in GEJ Siewert type II–III tumors and gastric adenocarcinoma (GAC). No cases of metastatic upstaging were observed in distal esophageal or Siewert type I tumors. The median PCI among patients with confirmed peritoneal involvement was 3. Poorly cohesive and signet ring cell histology showed a higher incidence of peritoneal dissemination compared with other subtypes. SL demonstrated a favorable safety profile, with low rates of intraoperative and postoperative complications. DISCUSSION The findings of this study confirm the added value of SL in detecting occult metastatic disease and refining staging in patients with locally advanced GEJ AC and GAC. In particular, Siewert type II tumors appear to exhibit a biological behavior more similar to GAC than distal esophageal AC, supporting a selective use of SL in this subgroup. The assessment of low-volume peritoneal disease and PCI proved essential for accurate staging and treatment planning. CONCLUSIONS SL represents a valuable and safe tool in the staging of selected patients with esophagogastric AC, particularly in GEJ Siewert type II–III tumors and GAC. Its integration into the staging algorithm improves diagnostic accuracy, prevents non-curative surgical interventions, and supports personalized multimodal treatment strategies. Further multicenter studies are warranted to refine patient selection and optimize staging protocols.