title: Laparoscopy alone is superior to peritoneal cytology in staging gastric and esophageal carcinoma.
abstract: BACKGROUND
  Laparoscopy identifies metastatic disease in patients with upper gastrointestinal malignancies; however, it has been suggested that cytological examination of peritoneal washings may increase the diagnostic yield. We hypothesize that the addition of cytologic washings to a standardized staging laparoscopy is unnecessary for the identification of intraabdominal metastasis in patients with gastric/esophageal cancer.
  
  
  METHODS
  Forty patients with gastric/esophageal cancer were prospectively evaluated. Patients successfully underwent a diagnostic laparoscopy protocol (with biopsies) during which peritoneal washings were obtained and processed for cytologic analysis. Laparoscopic versus cytologic identification of intraabdominal metastasis were compared.
  
  
  RESULTS
  Forty patients successfully completed laparoscopy with collection of peritoneal washings. Laparoscopic examination of the peritoneal cavity upstaged 21 (52.5%) patients. Laparoscopic examination consistently identified a statistically significant higher number of positive patients than cytologic examination of peritoneal washings (p = 0.001) and examination of cytologic washings alone failed to identify 45% of patients with positive findings and laparoscopy. The addition of cytologic examination added no additional stage IV patients to the laparoscopy-negative group.
  
  
  CONCLUSIONS
  A standardized laparoscopic examination alone is sufficient for the identification of intraabdominal metastatic disease in patients with gastric and esophageal cancer.
authors.affiliation: Department of Surgery, University of Texas Southwestern, Dallas, TX 75390, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Wilkiemeyer
authors.forename: S C
authors.initials: SC
authors.lastname: Bieligk
authors.forename: R
authors.initials: R
authors.lastname: Ashfaq
authors.forename: D B
authors.initials: DB
authors.lastname: Jones
authors.forename: R V
authors.initials: RV
authors.lastname: Rege
authors.forename: J B
authors.initials: JB
authors.lastname: Fleming
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D001706:Biopsy; D003581:Cytodiagnosis; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010533:Peritoneal Lavage; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000473:pathology*