Selection of locally advanced gastric carcinoma by preoperative staging laparoscopy.
BACKGROUND
The present study is a prospective evaluation of immediate preoperative laparoscopy compared to ultrasound/computed tomography (US/CT) staging for gastric cancer in a series of 100 patients observed at two major Italian hospitals from April 1995 through September 1996.


METHODS
After a complete preoperative work-up all c-M0 patients underwent laparoscopy immediately prior to an eventual surgical exploration. pTNM was considered as the gold standard for the evaluation of the results.


RESULTS
Laparoscopy detected 21 unsuspected M+ cases out of 100. As regards locally advanced tumors, laparoscopy showed a sensibility of 69.7% for T3 and 89.6% for T4, significantly higher than US/CT staging (23.2% and 48.3%, respectively; p < 0.02). In this series laparoscopic staging altered clinical staging in 58% of cases.


CONCLUSIONS
This procedure plays two crucial roles in the preoperative evaluation of advanced gastric cancer: It makes it possible to avoid unnecessary surgical exploration in M+ cases and, to date, it represents the most reliable and economic tool for the selection of locally advanced tumors in the light of neoadjuvant treatment.
D'Ugo
D M
DM
Department of General Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo Gemelli, 8, 00168-Rome, Italy.
Persiani
R
R
Caracciolo
F
F
Ronconi
P
P
Coco
C
C
Picciocchi
A
A
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000465:Algorithms; D017024:Chemotherapy, Adjuvant; D003663:Decision Trees; D005069:Evaluation Studies as Topic; D006801:Humans; D007558:Italy; D010535:Laparoscopy; D008207:Lymphatic Metastasis / Q000473:pathology; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D019564:Unnecessary Procedures; D014741:Video Recording