Abstract
Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precise staging is the pouring force behind the use of diagnostic laparoscopy (DL). Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Study design: In this prospective study, 62 patients with lower esophageal, gastric and peri-pancreatic carcinomas were joined after written informed consent. All patients were examined with laparoscopy and LUS with the help of frozen section analysis to any doubtful metastatic site, peritoneal fluid and ascitic fluid analysis. Results: DL helped us to avoid needless laparotomy in 22.5% of patients, reducing its post-operative complications, hospital stay and cost. DL also helped us to do palliative management either in the form of gastric bypass or laparoscopic celiac plexus block. Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies.
Highlights
Surgical resection of upper gastro-intestinal malignancies carries substantial morbidity and mortality
Pre-operative computerized tomography (CT) scan (Figure 1) chest was completed in every subject and was free of metastatic deposits; tumor markers (CEA, CA19.9) were prepared in selected cases; and routine pre-operative examinations were normal in all cases
All data collected during staging laparoscopy (SL) were established after exploration of operable cases and were correct except in only 4 cases giving Staging Laparoscopy (SL) and laparoscopic ultrasound (LUS) procedure specificity (77.8%), positive predictive value (91.8%), sensitivity (100%) and (100%) negative predictive value
Summary
Surgical resection of upper gastro-intestinal malignancies carries substantial morbidity and mortality. In many cases, these cancers are thought to be resectable until the phase of laparotomy, at which time widespread or metastatic disease is revealed, preventing resection [1]. The potential to avert a non-therapeutic laparotomy by means of precise and less aggressive staging is the pouring force behind laparoscopic staging of upper gastrointestinal malignancies. Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies
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