title: Technical considerations in laparoscopic staging for advanced gastric cancer.
abstract: OBJECTIVE
  Staging laparoscopy is useful for increasing the accuracy of preoperative tumor staging. Diagnostic laparoscopy has therefore been introduced to prevent unnecessary laparotomy in patients with unresectable cancers. However, the technique of laparoscopic observation remains controversial. In this study, we determined the efficacy of hand-assisted laparoscopic staging.
  
  
  METHODS
  We retrospectively studied 44 patients who underwent conventional (LS group) or hand-assisted laparoscopic staging (HALS group).
  
  
  RESULTS
  The T factors of the TNM staging system was accurately determined in 95% of the patients in the HALS group and 58.3% of the patients in the LS group (p<0.0060). A total of 33.3% tumors in the LS group and 10% in the HALS group were judged to be unresectable. The overall mean survival was longer in the HALS group (20.3±12.2 months) than in the LS group (15.8±11.9 months).
  
  
  CONCLUSIONS
  Laparoscopic diagnosis and staging of advanced gastric cancer are reliable. Moreover hand-assisted laparoscopic staging enables the accurate assessment of tumor resectability.
authors.affiliation: Department of Surgery, Yokohama Central Hospital , Yokohama, Japan. ooida.takatsugu@yokochu.jp
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Oida
authors.forename: Hisao
authors.initials: H
authors.lastname: Kano
authors.forename: Kenji
authors.initials: K
authors.lastname: Mimatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kuboi
authors.forename: Nobutada
authors.initials: N
authors.lastname: Fukino
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Kida
authors.forename: Sadao
authors.initials: S
authors.lastname: Amano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery