Laparoscopic Staging for Stage III Gastric Cancer

N/AEnrolling By InvitationNCT07533825

Tianjin Medical University Cancer Institute and Hospital968 enrolled

Overview

This study aims to determine, through a multicenter randomized controlled design, the impact of precision treatment guided by laparoscopic staging on overall survival (OS), surgical conversion rate, and peritoneal metastasis rate in patients with clinical stage III gastric cancer, thereby providing evidence for precision staging and treatment decision-making.

This study aims to compare, through a multicenter randomized controlled design, patients who undergo laparoscopic exploration staging before treatment (experimental group) with patients who receive treatment directly based on imaging findings (control group).Experimental Group: Will undergo laparoscopic exploration. If peritoneal metastasis (CY+ or P+) or cT4aN+ or cT4bN+ or M1 is found, recommendations include: Systemic therapy + NIPS ± HIPEC or HIPEC. If no metastasis is found, systemic neoadjuvant therapy is recommended.Control Group: Will not undergo laparoscopic exploration. Systemic therapy will be recommended directly based on imaging staging. The primary objective of this study is to compare the 3-year overall survival (OS) between the two groups (experimental group and control group). Overall survival is defined as the time from randomization or start of treatment to death from any cause, with the 3-year survival rate serving as the primary endpoint to evaluate the long-term survival benefit of the two treatment strategies. The secondary objectives of this study include the following three items:1.To evaluate the detection rate of peritoneal metastasis by laparoscopic staging (experimental group only).2.To evaluate the R0 resection rate after conversion surgery in both groups.3.To compare the surgical conversion rate (i.e., the proportion of patients who change from the original treatment plan to surgery) between the two groups.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

968

Conditions

Gastric Cancer (GC)Gastric Adenocarcinoma

Interventions

Laparoscopic Staging-Guided TherapyDEVICE

This intervention consists of a treatment strategy guided by findings from laparoscopic staging. If laparoscopic exploration reveals peritoneal metastasis (CY+ or P+), cT4aN+, cT4bN+, or M1 disease: Patients receive systemic therapy combined with NIPS (neoadjuvant intraperitoneal and systemic chemotherapy) ± HIPEC (hyperthermic intraperitoneal chemotherapy), or HIPEC alone. If laparoscopic exploration shows no peritoneal metastasis and the patient is cT3N+: Patients receive systemic neoadjuvant therapy alone, followed by imaging evaluation every 3-4 cycles and planned surgery. Postoperative treatment for the experimental group: After conversion therapy and surgery, systemic therapy + NIPS ± HIPEC or HIPEC is recommended. This intervention is distinguished from the comparator arm (which proceeds directly to systemic therapy without laparoscopic exploration and without intraperitoneal drug administration) by its use of laparoscopic staging to tailor treatment intensity and route, inc

Without Laparoscopic ExplorationDEVICE

Patients undergo upfront systemic therapy without laparoscopic exploration and without intraperitoneal drug administration.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Pathologically confirmed: Histologically proven adenocarcinoma of the stomach or gastroesophageal junction (Siewert type II/III). 2. Definitive pathological markers: Documented status of HER2, MMR, CPS (PD-L1) score, and Claudin 18.2. 3. Clinical stage: cT3/T4a N+ M0 based on contrast-enhanced CT, endoscopic ultrasound, or MRI (AJCC 8th edition): cT3: Tumor invades through the muscularis propria into the subserosa. cT4a: Tumor penetrates the visceral peritoneum. cN+: Regional lymph node metastasis (intra-abdominal regional nodes such as perigastric, celiac, or common hepatic artery lymph nodes: short-axis diameter \> 8 mm; other nodes such as retroperitoneal or para-aortic lymph nodes: short-axis diameter \> 10 mm). No evidence of peritoneal metastasis on imaging modalities other than laparoscopic exploration. 4. Age: 18 to 75 years, regardless of sex. 5. Performance status: ECOG score 0-2 (fully active to ambulatory and capable of self-care but unable to work). 6. Life expectancy: Estimated survival ≥ 6 months. 7. Surgical fitness: Adequate cardiopulmonary functional reserve and no contraindications to anesthesia. 8. Informed consent: Voluntary participation with written informed consent obtained. Exclusion Criteria: * 1\. \*\*Gastric outlet obstruction:\*\* Requiring gastrojejunostomy due to obstructive symptoms. 2\. \*\*Distant metastasis:\*\* Evidence of peritoneal, mesenteric, or omental metastasis and/or obvious ascites on imaging, or distant organ metastasis. 3\. \*\*Other malignancies:\*\* History of or concurrent other malignant tumors (except curatively treated basal cell carcinoma of the skin). 4\. \*\*Organ dysfunction:\*\* Severe cardiac insufficiency (NYHA class III-IV), hepatic dysfunction Child-Pugh class C, or creatinine clearance \< 30 mL/min. 5\. \*\*Contraindications to laparoscopy:\*\* History of severe intra-abdominal adhesions, coagulation disorders (INR \> 1.5 or platelet count \< 50 × 10⁹/L), or severe intestinal obstruction. 6\. \*\*Special populations:\*\* Pregnant or lactating women, or those unable to interrupt breastfeeding. 7\. \*\*Mental status:\*\* Cognitive impairment or psychiatric disorders that preclude compliance with follow-up.

Locations (1)

Tianjin Medical University Cancer Institute and Hospital,

Tianjin, Tianjin Municipality, China

Outcomes

Primary Outcomes

3-year Overall Survival (OS)

To compare the 3-year Overall Survival (OS) between the two groups.

Time frame: about 3 years

Secondary Outcomes

Laparoscopic Detection Rate of Peritoneal Metastasis

Detection Rate of Peritoneal Metastasis by Laparoscopic Exploration (DRPM-LE). This refers to the proportion of patients in whom peritoneal metastasis (including peritoneal seeding or positive peritoneal cytology) is identified via laparoscopic exploration. This outcome measure is used to assess the diagnostic value of laparoscopic staging in detecting peritoneal metastasis among patients with clinical stage III gastric cancer, and serves as a key parameter for evaluating the effectiveness of precision staging approaches.

Time frame: about 3 years

R0 Resection Rate

R0 Resection Rate After Conversion Surgery

Time frame: about 3 years

Laparotomy Conversion Rate

This refers to the proportion of patients in whom a laparoscopic procedure (exploration or surgery) is converted to open surgery due to factors such as extensive tumor invasion, technical difficulty, or intraoperative complications. This outcome measure assesses the safety and feasibility of laparoscopic staging and serves as a key indicator of whether precision staging effectively avoids unnecessary laparotomy in patients with clinical stage III gastric cancer.

Time frame: about 3 years

Data from ClinicalTrials.gov

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