Abstract
Purpose: To study the clinical outcome and scope of laparoscopic management in patients of cancer stomach. Methods: This is a prospective study of our first 25 patients of cancer stomach managed laparoscopically. Following procedures were undertaken: 1) Gastric resection in resectable cases; 2) Palliative bypass; 3) Tumor/ nodal/ peritoneal/ any other/ biopsy in cases of unresectable tumors. Results: Growth was resectable in 10 (40%) patients, and unresectable in 15 (60%) patients. Diagnostic laparoscopy had sensitivity of 100%, while other modalities of investigation were not totally useful in 1/3 to ½ of cases. Laparoscopic gastrojejunostomy was done in 5 (20%) patients, laparoscopy assisted distal partial gastrectomy was performed in 8 (32%) patients while totally laparoscopic gastrectomy was possible in 1 (4%) patient. Long term follow up was observed. Conclusion : In cancer stomach laparoscopy is a safe, effective, and cost effective means of directing appropriate therapy especially in patients requiring diagnostic, staging and palliative procedures.
Highlights
Gastric cancer is one of the leading causes of death from malignant diseases in India (Nandakumar et al.).[1]
Gastric resection with D1 lymphadenectomy with no residual neoplasm remains the gold standard treatment for cancer stomach, as it is the only treatment modality offering the possibility of cure for these patients.[3, 4, 5, 6]
Palliative laparoscopic gastric bypass is best that can be done for such patients
Summary
Gastric cancer is one of the leading causes of death from malignant diseases in India (Nandakumar et al.).[1]. Gastric resection with D1 lymphadenectomy with no residual neoplasm remains the gold standard treatment for cancer stomach, as it is the only treatment modality offering the possibility of cure for these patients.[3, 4, 5, 6] Correct staging is a prerequisite for the optimal treatment. Despite an increasingly sophisticated diagnostic armamentarium many patients with gastric malignancy continue to have the diagnosis of unresectable or metastatic disease made at exploratory laparotomy. Laparoscopic surgery is sensitive for staging gastric cancer especially identifying tumor deposits that cannot be detected by conventional imaging.[7] It can prevent open surgery in patients with inoperable disease. Gastric outlet obstruction is a common and often preterminal event for patients with inoperable neoplasms of the distal stomach. Palliative laparoscopic gastric bypass is best that can be done for such patients
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