Laparoscopic evaluation of the risk of locoregional recurrence after radical surgery for gastric cancer.
OBJECTIVE
we studied the diagnostic utility of laparoscopy in patients who underwent absolute radical surgery (R0) for gastric adenocarcinoma and who were at risk for locoregional recurrence. Risk was considered to exist in patients with T3-T4 stage tumors (IUAC TNM classification) that invaded the serosa or affect nearby organs. These patients are candidates for clinical trials involving multimodal therapies, especially with neoadjuvant or intraperitoneal chemotherapy.


METHODS
ninety consecutive patients with gastric adenocarcinoma diagnosed by endoscopic biopsy were studied. The tumors were considered to be operable and potentially resectable depending on the preoperative evaluation of spread. The gold standard was the pathology report, based on the resected piece or specific biopsies.


RESULTS
in T3-T4 tumors, laparoscopy had a sensitivity of 81% and a specificity of 100%, whereas for an 80% prevalence the positive predictive value was 100%, the negative predictive value was 56%, and diagnostic accuracy was 84%.


CONCLUSIONS
in global terms, laparoscopy is very useful in detecting and confirming malignant invasion of the serosa or neighboring organs. In this sense it is similar to other diagnostic staging techniques such as endoscopic echography, with the added advantages of requiring less operator skill and being available in any center where such tumors are treated.
Escrig Sos
V J
VJ
Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón de la Plana, 12004, España.
Asencio Arana
F
F
Todolí Tomás
G
G
Salvador Sanchís
J L
JL
Ruíz del Castillo
J
J
Corell Planelles
R
R
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D001499:Bayes Theorem; D001706:Biopsy; D016001:Confidence Intervals; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery