Predicting factors of unexpected peritoneal seeding in locally advanced gastric cancer: Indications for staging laparoscopy

Background and Objectives The aim of this study is to investigate predictive factors for unexpected peritoneal seeding from clinically resectable advanced gastric cancers to suggest the indications for staging laparoscopy (SL). Methods A total of consecutive 589 gastric cancer patients who were clinically diagnosed with advanced gastric cancer with no metastatic disease underwent operations at Seoul St. Mary's Hospital. Results A total of 72 patients (including 35 patients with seeding to distant peritoneum) were surgically diagnosed with peritoneal seeding. Borrmann type 3 (OR: 4.475) or type 4 (OR: 8.243) cancer, tumor invasion of T3 (OR: 2.794) or T4 (OR: 6.841) and tumor size (4 cm ≤ tumor size