title: Selection of locally advanced gastric carcinoma by preoperative staging laparoscopy.
abstract: 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.
authors.affiliation: Department of General Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo Gemelli, 8, 00168-Rome, Italy.
authors.forename: D M
authors.initials: DM
authors.lastname: D'Ugo
authors.forename: R
authors.initials: R
authors.lastname: Persiani
authors.forename: F
authors.initials: F
authors.lastname: Caracciolo
authors.forename: P
authors.initials: P
authors.lastname: Ronconi
authors.forename: C
authors.initials: C
authors.lastname: Coco
authors.forename: A
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: 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