title: Feasibility and accuracy of second-look laparoscopy after gastrectomy for gastric cancer.
abstract: BACKGROUND
  A better method for detecting early peritoneal progression is needed. This study evaluated the feasibility and accuracy of second-look laparoscopy for patients with gastric cancer treated using systemic chemotherapy after gastrectomy.
  
  
  METHODS
  Second-look laparoscopy was conducted for patients who had no clinical evidence of distant metastases but had peritoneal metastases or positive peritoneal cytology results without visible metastatic disease at initial surgery, patients who underwent systemic chemotherapy over a 6-month period after surgery, and patients who had no clinical evidence of disease based on imaging study after completion of primary chemotherapy.
  
  
  RESULTS
  Between November 2004 and April 2008, 21 patients underwent second-look laparoscopy. At the initial surgery, 13 of these patients underwent total gastrectomy and 8 patients underwent distal gastrectomy. One or two sheets of adhesion barrier were received by 18 patients. The median interval between initial surgery and second-look laparoscopy was 9.8 months (range, 6.6-17.5 months). All second-look procedures were completed laparoscopically, and no patients required conversion to laparotomy. None of the 21 patients experienced postlaparoscopy complications. Whereas 12 patients showed no pathologic evidence of disease, 9 patients showed disease at second-look laparoscopy. There was a significant difference in median survival between the groups with negative and positive results (p = 0.017). The median survival for the negative group has not been determined. All the patients in the positive group received further chemotherapy while showing a good performance status (PS). Six patients were PS 0, and 3 patients were PS 1. The median survival time for this group was 10.1 months.
  
  
  CONCLUSIONS
  Second-look laparoscopy was a safe and promising approach to reassessment of peritoneal disease for patients with gastric cancer. The incidence of complications was low, particularly in this group of patients, all of whom had undergone prior gastrectomy.
authors.affiliation: Department of Surgery, Kansai Medical University, 2-3-1 Sinmachi, Hirakata, Osaka, 573-1191, Japan. inoueke@hirakata.kmu.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakane
authors.forename: Taku
authors.initials: T
authors.lastname: Michiura
authors.forename: Sou
authors.initials: S
authors.lastname: Yamaki
authors.forename: Rintaro
authors.initials: R
authors.lastname: Yui
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Sakuramoto
authors.forename: Aiko
authors.initials: A
authors.lastname: Iwai
authors.forename: Katsuji
authors.initials: K
authors.lastname: Tokuhara
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Araki
authors.forename: Songtae
authors.initials: S
authors.lastname: Kim
authors.forename: Koji
authors.initials: K
authors.lastname: Nakai
authors.forename: Mutsuya
authors.initials: M
authors.lastname: Sato
authors.forename: Keigo
authors.initials: K
authors.lastname: Yamamichi
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D024162:Second-Look Surgery; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate