Evaluation of the role of laparoscopic ultrasonography in the staging of oesophagogastric cancers.
BACKGROUND
The role of laparoscopic ultrasound (LUS) during staging laparoscopy for pancreatic cancers is established but remains debatable in evaluating oesophagogastric cancers.


METHODS
A retrospective consecutive case series consisting of patients undergoing staging laparoscopy in two centres (centre A and B) was carried out over a 5-year period (2000-2005). Patients in centre B underwent LUS following laparoscopic assessment using a 7.5-MHz probe. Staging laparoscopy in both centres was performed using a standardised three-port protocol using a 30 degrees laparoscope. All suspicious lesions were sent for histological assessment for confirmation of malignancy.


RESULTS
There were 201 patients in centre A (83 gastric, 138 lower oesophageal/junctional cancers) and 119 patients in centre B (51 and 68, respectively). There were no differences between the two centres for patient demographics and tumour site. There was no difference between the two centres for the detection of metastatic disease using laparoscopic assessment alone (A 13% versus B 20%, p = 0.12). However, there was a significant difference (13% versus 28%, p = 0.001) with the additional use of LUS in centre B. The findings in the additional 8% (n = 9) were para-aortic lymphadenopathy (n = 5), liver metastasis (n = 3) and local extension (n = 1). Five had gastric and four lower oesophageal/junctional cancers. The negative predictive value was 6.4% for centre A and 4.5% for centre B.


CONCLUSIONS
The addition of LUS increased the detection rate of metastasis by 8% but there was little impact on the false-negative rate. LUS is useful in detecting metastatic lymphadenopathy beyond the limits of curative resection and liver metastasis.
Samee
Abdus
A
Division of Upper GI Surgery, University Hospital of North Staffordshire, Stoke On Trent, UK. doscsamee@hotmail.com
Moorthy
Krishna
K
Jaipersad
Tony
T
Crisp
William
W
Cheruvu
Chandra
C
Elder
James
J
Deakin
Mark
M
D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D009367:Neoplasm Staging / Q000295:instrumentation / Q000379:methods*; D010386:Pelvic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018084:Ultrasonography, Interventional / Q000295:instrumentation