title: Laparoscopy significantly improves the perceived preoperative stage of gastric cancer.
abstract: BACKGROUND
  The aim of this study was to examine the accuracy of laparoscopy is staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination.
  
  
  METHODS
  One hundred patients out of a consecutive series of 258 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw).
  
  
  RESULTS
  The strengths of agreement between the CT stage and the final histopathological stage were Kw = 0.336 (95% confidence interval [CI]; 0.172-0.5; P = 0.0001) for T stage and 0.378 (95% CI; 0.226-0.53; P = 0.0001) for M stage, compared with 0.455 (95% CI; 0.301-0.609; P = 0.0001) and 0.73 (95% CI; 0.596-0.864; P = 0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 21 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT.
  
  
  CONCLUSIONS
  Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination.
authors.affiliation: Department of Surgery, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK.
authors.forename: Guy R J C
authors.initials: GR
authors.lastname: Blackshaw
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Barry
authors.forename: Paul
authors.initials: P
authors.lastname: Edwards
authors.forename: Miles C
authors.initials: MC
authors.lastname: Allison
authors.forename: Gerald V
authors.initials: GV
authors.lastname: Thomas
authors.forename: Wyn G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D005188:False Negative Reactions; D006801:Humans; D010535:Laparoscopy; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed