title: Laparoscopy and laparoscopic ultrasonography in staging of carcinoma of the esophagus and gastric cardia.
abstract: BACKGROUND
  The objective of this prospective study was to assess the contribution of laparoscopy combined with laparoscopic ultrasonography (LLU) in the preoperative staging of patients with carcinoma of the esophagus and cardia.
  
  
  METHODS
  Preoperative LLU was performed in 56 patients who were selected for curative resection of carcinoma of the esophagus (n = 38) or gastric cardia with involvement of the distal esophagus (n = 18) after routine preoperative workup. During LLU, the peritoneal cavity was scrutinized for metastatic disease, and ultrasonography of the liver and celiac axis was performed. In all patients without histologically proven metastases, laparotomy was then performed.
  
  
  RESULTS
  The morbidity rate of the procedure was 3.5 percent (two superficial wound infections). In three (5 percent) of the 56 patients, laparotomy was excluded by the presence of intra-abdominal metastases. In three other patients, laparotomy was necessary to confirm the suspected hepatic or peritoneal metastases, or both, because histologic proof was not obtained at laparoscopy. In one patient, LLU failed to detect a small hepatic metastasis in segment VII. The preoperative stage was altered by laparoscopy in nine (17 percent) patients (M1 in six, T4 in three). Laparotomy was avoided in two (11 percent) and the preoperative stage changed in seven patients (41 percent), all of whom had carcinoma of the gastric cardia, as occurred in one (3 percent) and two (6 percent) patients with middle and distal carcinoma of the esophagus, respectively.
  
  
  CONCLUSIONS
  Preoperative staging by LLU is of little value in patients with carcinoma of the middle and lower esophagus. The probable role of LLU in the staging of patients with carcinomas of the gastric cardia remains to be confirmed in larger series.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Leiden, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: O M
authors.initials: OM
authors.lastname: van Delden
authors.forename: J J
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: N J
authors.initials: NJ
authors.lastname: Smits
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: H
authors.initials: H
authors.lastname: Obertop
mesh_terms: D002299:Cardia; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011300:Preoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography