title: [Role of diagnostic laparoscopy in the treatment plan of gastric cancer].
abstract: OBJECTIVE
  To assess the clinical value of the diagnostic laparoscopy in choosing treatment strategies for patients with gastric cancer.
  
  
  METHODS
  Retrospective analysis was performed on clinical and pathological data collected from 2 023 patients undergoing gastric cancer surgery in the Zhongshan Hospital of Fudan University from 2009 to 2014. All the patients were diagnosed as gastric cancer by endoscopic biopsy and staged by imaging examination before surgery. During the diagnostic laparoscopy procedure, a small periumbilical incision was made and a pneumoperitoneum with CO2under 10-15 mmHg was established through a port. A 10 mm trocar was put in, and the camera was inserted. Two 5 mm trocars were put in two ports which located in midclavicular line two fingers under the left and right costal margin and then the instruments were inserted. A thorough inspection included ascites, the abdominal cavity, liver, diaphragm, spleen, greater omentum, colon, small intestine, mesentery, adnexa (female) and pelvic floor. If the tumor located at the posterior part of the stomach, the gastrocolic ligament was opened in order to look for carcinomatosis in the omental bursa. The accuracy rate of diagnostic laparoscopy in diagnosing adjacent organ invasion and intra-abdominal metastasis was calculated, and the rate of adjusting treatment plans after diagnostic laparoscopy was also calculated.
  
  
  RESULTS
  There were 52.7%(1 067/2 023) of patients underwent diagnostic laparoscopy. The accuracy rate of diagnostic laparoscopy in evaluating adjacent organ invasion and intra-abdominal metastasis were 98.3%(1 049/1 067) and 98.1%(1 047/1 067) respectively. Besides, 14 patients with stage T4b and 32 with intra-abdominal metastasis, which were missed by imaging examination, were diagnosed by diagnostic laparoscopy. The treatment plans of 9.3% (99/1 067) of patients were changed after diagnostic laparoscopy, and 65 (6.1%) cases of non-therapeutic laparotomy were avoided. However, 18 cases of adjacent organ invasion and 20 cases of intra-abdominal metastasis were still missed by diagnostic laparoscopy, and 12 cases received non-therapeutic laparotomy.
  
  
  CONCLUSIONS
  Diagnostic laparoscopy has considerable value in assessing adjacent organ invasion and intra-abdominal metastasis and has great clinical significance in making precise treatment plans.
authors.affiliation: Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Haojie
authors.initials: H
authors.lastname: Li
authors.affiliation: Fudan University School of Medicine, Shanghai 200032, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Lingqiang
authors.initials: L
authors.lastname: Min
authors.affiliation: Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. liu.fenglin@zs-hospital.sh.cn.
authors.forename: Fenglin
authors.initials: F
authors.lastname: Liu
authors.affiliation: Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Yihong
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D004064:Digestive System / Q000473:pathology; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging*; D010347:Patient Care Planning / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D013525:Surgical Instruments; D019564:Unnecessary Procedures / Q000706:statistics & numerical data