Advantages of laparoscopic palliative surgery in upper GI tract cancer

Abstract

Generally, the resection rate in advanced oesophageal and gastric carcinoma varies between 30 and 50% and palliative surgery results in 5 year survival of below 15% (1, 2). These data demonstrate that patients with advanced upper gastrointestinal (GI) tract cancer rarely benefit from extensive operative procedures and therefore non-surgical palliation should be considered. In spite of advances in diagnostic studies, it still remains a challenge to correctly define the extent of the disease, especially in oesophageal and gastric cancer. Consequently, exact assessment of resectability and curability of cancer of the upper GI tract is frequently achieved only by laparotomy. However, a high rate of exploratory laparotomy is found in these patients because of nonresectable disease or disseminated tumour spread and this procedure has been associated with considerable morbidity and mortality. Serious complications related to laparotomy have been reported in 15-25% of patients with gastric cancer resulting in a mortality of about 25% (3). Laparoscopy is a minimally invasive technique that enables sensitive assessment of intra-abdominal tumour spread. Besides the diagnostic application, this technique may be useful for surgical palliation in advanced GI tract cancer. The purpose of this study was to evaluate the impact of laparoscopy on staging and palliation of advanced upper GI tract cancer.