INTRAOPERATIVE FLUORESCENCE DIAGNOSIS OF PERITONEAL DISSEMINATION IN PATIENTS WITH GASTRIC CANCER

Abstract

The study of diagnostic efficiency of intraoperative fluorescence diagnosis (IOFD) of peritoneal dissemination in patients with gastric cancer comparing with standard laparoscopy was performed in P.A. Hertsen MCRI (the branch of NMRRC). The study included 114 patients with verified diagnosis of gastric cancer stage III–IV. For IOFD the domestic medication alasens (the active agent – 5-aminolevulinic acid) was used orally at dose of 30 mg/kg body weight 3 h prior to the study procedure. As the result of fluorescence diagnosis 10 (6.9%) patients had peritoneal tumor dissemination verified morphologically and undetected by standard laporoscopy. The sensitivity of peritoneal revision for standard laparoscopy in patients with gastric cancer stage III–IV was 60.8%, the specificity – 75.8%, the overall accuracy – 69.1%. The sensitivity for IOFD in patients with gastric cancer stage III–IV was 91.1%, the specificity – 93.9%, the overall accuracy – 92.7%. Thus, fluorescence study allowed improving the specificity, the sensitivity and the overall accuracy of diagnostic test. In the trial IOFD had the maximal diagnostic value in patients with visually undetectable microdissemination in «whight» light and with solitary visible peritoneal foci (the average number of additionally detected metastatic lesions in one patient – 1.22 and 1.4, respectively). Moreover, in the case of fluorescence diagnosis the number of detected microfoci of peritoneal dissemination was showed to increase with enlargement of area of tumor invasion to gastric serosa (at average of 2.29 additionally detected lesions in one patient with serosal invasion more than 2 cm2). The obtained results confirm the perspective of use of fluorescence diagnosis for detection of peritoneal dissemination, determination of true tumor extent, staging of the tumor and also for adjustment of following treatment tactics for this group of patients.