Immediately preoperative laparoscopic staging for gastric cancer.
BACKGROUND
This ongoing study is a prospective evaluation of immediately preoperative video-laparoscopy compared to ultrasound/computed tomography (US/CT) staging for gastric cancer. An analysis of the first 70 cases is reported.


METHODS
TNM staging is used to compare the US/CT findings and the laparoscopic findings with the gold standard for pathologic findings in resected specimens.


RESULTS
In our series 47 out of 70 cases are locally advanced cancers (stages III and IV): In this subset the predictive value of laparoscopic staging is 86.4%. Laparoscopy shows an overall staging accuracy of 68.6%, compared to 32.8% for US/CT. The difference is statistically significant as regards the T factor (T3: 69.7% vs 12. 1%, p < 0.002; T4: 84.2% vs 42.1%, p < 0.05); as regards the M factor, laparoscopy appears the most specific method for detecting peritoneal seeding.


CONCLUSIONS
This procedure plays a crucial role in determining the resectability of the tumor, thus avoiding unnecessary laparotomies. A meticulous staging becomes mandatory when applying modem treatment options (e.g., neo-adjuvant chemotherapy) to locally advanced cancers; in this context the use of staging laparoscopy will have a relevant impact on future treatment.
D'Ugo
D M
DM
Department of General Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo Gemelli, 8, 00168-Rome, Italy.
Coppola
R
R
Persiani
R
R
Ronconi
P
P
Caracciolo
F
F
Picciocchi
A
A
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014741:Video Recording