Abstract
Gastric cancer continues to be a leading cause of cancer death. The majority of patients with gastric adenocarcinoma in China present with advanced disease. Ruling out unresectable cancers from an unnecessary ''open'' exploration is very important. The aim of this study was to assess the value of five-port anatomical laparoscopic exploration in T4 gastric cancer in comparison with three-port laparoscopic exploration and laparotomy exploration. We conducted a retrospective study on 126 patients with T4 stage scheduled for D2 curative gastrectomy based on computed tomography (CT) staging at Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, from Apr. 2011 to Apr. 2013. Laparotomy exploration (Group I), three-port laparoscopic exploration (Group II) or five-port anatomical laparoscopic exploration (Group III) were performed prior to radical gastrectomy. Accuracy rate for feasibility of D2 curative gastrectomy in laparotomy exploration and five-port anatomical laparoscopic exploration groups was higher than that in the three-port laparoscopic exploration group. Five-port anatomical laparoscopic exploration group had the highest accuracy resection rate (Group I vs Group II vs Group III,92.6% vs78.6% vs 97.7%; p<0.05) and shorter length of hospitalization (Group I vs Group II vs Group III, 9.58±4.17 vs 6.13±2.85 vs 5.00±1.81; p<0.001). Three-port laparoscopic exploration has low accuracy rate for assessing feasibility of D2 curative gastrectomy and five-port anatomical laparoscopic exploration should be performed on patients with T4 gastric cancer.
Highlights
Gastric cancer is the second leading cause of cancerrelated deaths worldwide (Bertuccio et al, 2009; Strong et al, 2012; Jemal et al, 2013)
We evaluated the usefulness of five-port anatomical laparoscopic exploration to decide the resectability of gastric cancers
computed tomography (CT) and EUS are not sensitive enough to detect the small metastatic intra-abdominal deposits typical of gastric adenocarcinoma, specially to identify patient who can be resectable (Burbidge et al, 2013). It is precisely this group of patients that would benefit from five-port anatomical laparoscopic exploration
Summary
Gastric cancer is the second leading cause of cancerrelated deaths worldwide (Bertuccio et al, 2009; Strong et al, 2012; Jemal et al, 2013). Surgical resection remains the only curative treatment for patients with gastric cancer. Surgical resection is dependent on the accuracy of the disease staging. Accurate preoperative staging can help reduce the number of unnecessary surgeries and decide other options of treatment. Technique of laparoscopy-assisted gastric cancer resection was reported widely (Zhang et al, 2014). Laparoscopy may detect occult metastatic diseases and spare the patient an unnecessary laparotomy, result in fewer complications, and reduce the substantial morbidity and mortality associated with nontherapeutic laparotomy The liver, diaphragm, serosal surfaces, peritoneum, omentum, and pelvic organs can be systematically inspected. The three-port laparoscopic exploration is difficult to define evaluation of posterior infiltration of the tumor. We evaluated the usefulness of five-port anatomical laparoscopic exploration to decide the resectability of gastric cancers
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