Laparoscopic staging for gastric cancer

Abstract

Laparoscopy has become an increasingly important diagnostic tool for the staging of intraabdominal malignancies. Some investigators have suggested laparoscopy to be of questionable value in the preoperative staging of gastric cancer because many patients may require palliative surgery despite laparoscopic findings. However, in other studies laparoscopy was found to be a more accurate staging technique and useful in avoiding unnecessary laparotomy when compared with abdominal sonography, liver scintigraphy, or early generation computed tomography (CT). In recent years marked improvements have been made in CT technology, and laparoscopy has not been compared with current generation CT. Therefore we sought to determine the usefulness of laparoscopy for staging gastric adenocarcinoma in the era of current generation CT scanning. Staging laparoscopy was performed in 71 patients with potentially resectable gastric cancer as determined by physical examination and current generation CT. The results of laparoscopy were evaluated in the context of negative or equivocal CT findings. Laparoscopic staging was successful in 69 patients (97%). Laparoscopy identified distant metastatic disease in 16 (23%) patients judged to be eligible for potentially curative resection by current generation CT scanning. Only one of these patients required laparotomy for palliation. Combined CT and laparoscopic staging resulted in a 93% resectability rate for patients operated on with curative intent. We advocate staging laparoscopy as an important staging procedure for all patients with potentially resectable gastric cancer. The additional cost of laparoscopy should be more than offset by the decreased morbidity and expense of hospitalization for those patients who avoid an unnecessary laparotomy.