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Laparoscopy with Peritoneal Lavage

Approximately half of gastric cancer patients with metastatic disease have cancer involving the peritoneum.306 Current imaging techniques such as EUS and CT have limited ability to detected peritoneal dissemination. In fact, up to one third of patients with seemingly resectable disease will have evidence of peritoneal spread at the time of staging laparoscopy.346 National Comprehensive Cancer Network guidelines recommend consideration of laparoscopy with peritoneal lavage for patients with seemingly resectable disease in whom neoadjuvant chemotherapy is being considered.347 However, the United States has been slow to adopt this practice; a study using SEER-Medicare data found that only 8% of gastric cancer patients who had any surgery underwent laparoscopy.348