Usefulness of laparoscope for the staging of advanced gastric cancer without distant metastasis in abdominal CT and EUS

Hur, Byung Won; Chun, Hoon Jai; Jeen, Yoon Tae; Kang, Chang Don; Lee, Jung Whan; Lee, Hong Sik; Song, Chi Wook; Um, Soon Ho; Lee, Sang Woo; Choi, Jai Hyun; Kim, Chang Duck; Ryu, Ho Sang; Hyun, Jin Hai

Abstract

BACKGROUND: The proper staging of advanced gastric cancer has crucial role in determining resectability and operative method, to prevent unnecessary operation and to predict the prognosis and survival rate. Although marked improvements have been made in computed tomography (CT) technology and endoscopic ultrasonography (EUS) in recent years, reassessment of the laparoscopy for gastric cancer is required as a preoperative staging tool. Therefore, we determined the usefulness of laparoscopy for staging of advanced gastric cancer without distant metastasis in CT and EUS.
METHODS
Staging laparoscopy was performed in 48 patients with advanced gastric cancer staged T3 or T4 by CT and EUS. Laparoscopy was carried out with the patients under local anesthesia, and included visual inspection of abdomen, and biopsies for suspicious metastatic lesions. Laparoscopic results were compared with the postoperative pathologic findings.
RESULTS
Laparoscopy was performed successfully in 48 patients. Laparoscopy disclosed unrecognized distant metastases in 7 patients (14.6%) judged to be eligible for potentially curative resection by CT and EUS. Preoperative laparoscopy showed an accuracy of 74% for serosal infiltration.
CONCLUSION
Our results suggest that laparoscopy is an effective means of evaluating resectability of advanced gastric cancer staged T3 or T4 and can provide valuable help in planning surgical approach.