Impact of diagnostic laparoscopy in the management of gastric cancer in Egyptian patients

Abstract

Background Gastric cancer (GC) is one of the leading causes of cancer-related deaths. In Egypt, it is the 14th among cancers mortality. Preoperative imaging as Computed Tomography and Endoscopic Ultrasonography have limitations in predicting the advanced disease, leading to many unnecessary laparotomies with more morbidity and mortality. Therefore, diagnostic laparoscopy (DL) may play a vital role in preoperative staging. The aim of the work was to evaluate the role of diagnostic laparoscopy (DL) in detecting peritoneal, liver metastasis and malignant ascites. Methods 40 patients of GC were involved, preoperative abdomen CT scan was done. DL was done under general anesthesia through 3 ports, the liver and whole peritoneal surfaces were examined for any metastasis, also any ascites was aspirated if there was no ascites irrigation with saline was done and re-aspirated. Any metastasis was biopsied and examined by frozen section also any aspirate was underwent immediate cytological examination. Results DL was positive in 12 patients (30%), detected as the following; 6 patients with liver deposits, 4 patients with peritoneal deposits and 2 patients with positive cytology. Therefore these 12 patients avoided unnecessary laparotomy, while the remaining 28 patients underwent curative resection of the tumor. Conclusion About 30% of GC is advanced once diagnosed. DL may be very helpful in detecting metastatic tumor missed by CT scan. Liver metastasis is the commonest metastasis of GC. Patients with positive DL avoid unnecessary laparotomy, and this does not delay them of having palliative treatment.