Evidence map›Paper›PMID 39503948›Full record

Observational studyAnnals of surgical oncology2025

The Impact of Diagnostic Laparoscopy on Upstaging Patients with Siewert II and III Gastroesophageal Junction (GEJ) Cancer.

Nathan J Alcasid, Deanna Fink, Kian C Banks, Cynthia J Susai, Katherine Barnes, Rachel Wile, Angela Sun, Ashish Patel, Simon Ashiku, Jeffrey B Velotta

Abstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Apples, Oranges, and ESOPEC Recurrence Patterns.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025
    Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Nathan J AlcasidDepartment of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA. nathanalcasid@gmail.com.
Deanna FinkDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Kian C BanksDepartment of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
Cynthia J SusaiDepartment of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
Katherine BarnesDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Rachel WileDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Angela SunDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Ashish PatelDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Simon AshikuDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Jeffrey B VelottaDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe efficacy of routine diagnostic laparoscopy with cytologic evaluation for gastroesophageal junction (GEJ) cancer is variable with no set guidelines. We hypothesize that findings from diagnostic laparoscopy in Siewert II and III GEJ tumors may differ, where routine diagnostic laparoscopy with washings yields low upstaging results in Siewert II compared with Siewert III tumors. PATIENTS AND

methodsWe reviewed patients with Siewert II/III GEJ cancer from 2012 through 2022 within our integrated health system. Chi-squared, Fisher's exact, and two-sample Wilcoxon rank-sum tests were utilized. The outcomes measured include likelihood of upstaging, cytology positivity, times to chemotherapy and surgery, and 5-year mortality using a multivariable Cox regression model.

resultsOf 265 patients with Siewert II diagnosis, 116 patients underwent a diagnostic laparoscopy while 149 patients did not. Median time to chemotherapy initiation and definitive surgery were increased among patients with diagnostic laparoscopy, with no difference observed in 5-year survival. For patients with Siewert II and III with a diagnostic laparoscopy, 5% of Siewert II were upstaged, compared with 17% of Siewert III (p = 0.025). Obtaining cytologic washings alone were less likely to be upstaged compared with receiving a biopsy with or without washings (5.2% vs. 17.3%, p = 0.039), and those with Siewert II were less likely than Siewert III to be upstaged after diagnostic laparoscopy (5.2% vs. 17.4%, p = 0.025).

conclusionsRoutine diagnostic laparoscopy yields a low upstaging rate in Siewert II GEJ adenocarcinomas (AC) while delaying treatment with no improvement on mortality. Expediting definitive surgery with selective biopsy in lieu of diagnostic laparoscopy may improve oncologic outcomes.

Indexed as

Endoscopy, Digestive SystemEsophagogastric JunctionLaparoscopyNeoplasm StagingStomach NeoplasmsAgedBiopsyDelayed DiagnosisDiagnostic ErrorsFemaleHumansKaplan-Meier EstimateMaleProportional Hazards ModelsRetrospective StudiesTime FactorsGastroesophageal junction (GEJ) tumorsNeoadjuvant therapySiewert classification

Identifiers

PMID39503948
PMCPMC11659370

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.