Video-laparoscopic staging of gastric cancer. A prospective multicenter comparison with noninvasive techniques.
BACKGROUND
The high proportion of gastric carcinomas present in an unresectable stage, together with the emergence of multimodal treatments, increases the usefulness of objective staging methods that avoid unnecessary laparotomies.


METHODS
A prospective evaluation of the accuracy of laparoscopy in the staging of 71 patients with gastric adenocarcinoma is presented. Serosal infiltration, retroperitoneal fixation, metastasis to lymph nodes, peritoneal and liver metastasis, and ascites were determined in the staging workup. Sensitivity, specificity, and predictive values were calculated and compared with those obtained with ultrasonography (US) and computed tomography (CT).


RESULTS
The diagnostic accuracy of laparoscopy in the determination of resectability was 98.6%. Consequently, over 40% of patients were spared unnecessary laparotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes studied. Our technique permits accurate assessment and pathologic verification of liver and the peritoneal and retroperitoneal extent of tumor invasion in the majority of patients.


CONCLUSIONS
Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage, thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup combining imaging and minimally invasive techniques is proposed.
Asencio
F
F
Hospital Arnau de Vilanova, Valencia, Spain.
Aguiló
J
J
Salvador
J L
JL
Villar
A
A
De la Morena
E
E
Ahamad
M
M
Escrig
J
J
Puche
J
J
Viciano
V
V
Sanmiguel
G
G
Ruiz
J
J
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000473:pathology; D005069:Evaluation Studies as Topic; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012187:Retroperitoneal Space; D012680:Sensitivity and Specificity; D012704:Serous Membrane / Q000473:pathology; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014741:Video Recording