Preoperative Staging Of Gastric Cancer Research Articles

Prognostic study of gastric cancer without serosal invasion: reevaluation of the definition of early gastric cancer

Background: Early gastric cancer, a term defined by Japanese researchers in the 1960s, is equivalent to pT1 tumor stage regardless of nodal status. Recently, there were suggestions to exclude node-positive pT1 gastric cancer from this entity and to consider node-negative pT2 gastric cancer as early gastric cancer. Study Design: A survival analysis was conducted of 294 patients who underwent resection for gastric cancers confined within the gastric wall (pT1, n = 164; pT2, n = 130) between 1986 and 1992. Results: The cumulative 5-year survival rate was 93.5% for pT1 patients and 67.9% for pT2 patients, with an overall survival of 82.5%. There was a significant difference in the 5-year survival rate between node-positive and node-negative pT1 patients (72.8% versus 95.6%; p = 0.0095). The 5-year survival rate of node-negative pT2 patients (80.4%) was significantly worse than that of node-negative pT1 patients (p = 0.011) but was not significantly better than that of node-positive pT1 patients (p = 0.4). If excellent prognosis is a prerequisite for the definition of early gastric cancer, then node-positive pT1 cancer and node-negative pT2 cancer should not be considered early gastric cancer. Conclusions: In the 1990s, now that new imaging techniques such as endoscopic ultrasonography has been introduced, the preoperative staging of gastric cancer can be made more accurately than in the 1960s, when the term “early gastric cancer” was defined. Because the prognosis of early gastric cancers, if subcategorized by nodal status, is not homogeneously excellent, a reevaluation of the definition of early gastric cancer may be necessary.

Prognostic study of gastric cancer without serosal invasion: reevaluation of the definition of early gastric cancer.

Early gastric cancer, a term defined by Japanese researchers in the 1960s, is equivalent to pT1 tumor stage regardless of nodal status. Recently, there were suggestions to exclude node-positive pT1 gastric cancer from this entity and to consider node-negative pT2 gastric cancer as early gastric cancer. A survival analysis was conducted of 294 patients who underwent resection for gastric cancers confined within the gastric wall (pT1, n = 164; pT2, n = 130) between 1986 and 1992. The cumulative 5-year survival rate was 93.5% for pT1 patients and 67.9% for pT2 patients, with an overall survival of 82.5%. There was a significant difference in the 5-year survival rate between node-positive and node-negative pT1 patients (72.8% versus 95.6%; p = 0.0095). The 5-year survival rate of node-negative pT2 patients (80.4%) was significantly worse than that of node-negative pT1 patients (p = 0.011) but was not significantly better than that of node-positive pT1 patients (p = 0.4). If excellent prognosis is a prerequisite for the definition of early gastric cancer, then node-positive pT1 cancer and node-negative pT2 cancer should not be considered early gastric cancer. In the 1990s, now that new imaging techniques such as endoscopic ultrasonography has been introduced, the preoperative staging of gastric cancer can be made more accurately than in the 1960s, when the term "early gastric cancer" was defined. Because the prognosis of early gastric cancers, if subcategorized by nodal status, is not homogeneously excellent, a reevaluation of the definition of early gastric cancer may be necessary.

Spiral computed tomography and operative staging of gastric carcinoma: a comparison with histopathological staging

Background—Much controversy exists as to the value of computed tomography (CT) in the preoperative staging of gastric cancer, because of its limited ability to identify correctly lymph node (LN) metastases,...

Prospective comparison of laparoscopy, ultrasonography and computed tomography in the staging of gastric cancer

A total of 103 consecutive patients with gastric adenocarcinoma was assessed for intra-abdominal spread of malignancy using ultrasonography, computed tomography (CT) and laparoscopy under general anaesthesia. Histologically proven metastases were to the liver in 27 patients, lymph nodes in 49 and directly to peritoneum in 13. All modalities showed a high specificity (92-100 per cent) for each type of metastasis. Laparoscopy was more sensitive in detecting hepatic, nodal and peritoneal metastases; the relative performance of laparoscopy was best with regard to hepatic metastases. Ultrasonography and CT were particularly poor at detecting nodal and peritoneal metastases. There was no significant morbidity and no mortality associated with laparoscopy, which was more accurate in preoperative staging of gastric cancer than ultrasonography or CT.

Laparoscopic staging for gastric cancer

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.

Preoperative staging of gastric cancer as precondition for multimodal treatment.

Preoperative staging of gastric cancer plays a crucial role every multimodal treatment protocol. At present, staging intends to be far more than evaluation of the depth of tumor infiltration into the organ wall, that is, T stage, nodular status (N category), and the presence of distant metastases (M stage) according to UICC criteria. In modern surgical oncology it includes more often the evaluation of prognostic factors such as the RAS-protein, p53 tumor suppressor gene, growth factor receptors, cell adhesion molecules, proteolytic factors, and proliferation-associated antigens. Furthermore, evaluation of nodular status is possible by sophisticated computer programs. The conventional staging of gastric cancer using endoscopy and sonography, conventional ultrasonography, computed tomography, and magnetic resonance imaging is discussed. Possible improvements of staging in oncologic centers should include surgical laparoscopy, laparoscopic ultrasonography, and meticulous evaluation of an abdominal lavage including immunohistochemical detection of free tumor cells. The most promising tumor biology-related prognostic factors in gastric cancer are briefly discussed.

The Japanese experience with endoscopic ultrasonography in the staging of gastric cancer.

The Japanese experience with endoscopic ultrasonography in the staging of gastric cancer is reviewed and compared with Western results. Various graphic classifications for prediction of the depth of transmural penetration characterize the Japanese approach. Differentiation of early gastric cancers from advanced cancers has been emphasized, with the concordance rate of the ultrasonographic interpretation and the pathology exceeding 90%. When pre-operative staging by the TNM system was attempted, results were similar to the reports from the West, with overall concordance rate for tumor depth of greater than 80%. The Japanese system of classification may be useful in differentiating advanced cancers from early gastric cancers with co-existing ulceration and fibrosis. The reliability of endoscopic ultrasonography in the pre-operative staging of gastric cancer in Japan is similar to that in the West.

Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT.

Fifty consecutive patients with gastric adenocarcinoma proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US). Dynamic computed tomography (CT) of the chest and abdomen was performed before surgery in 33 of the patients. In all 50 patients, the TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic findings in specimens resected at surgery. When the depth of tumor penetration was evaluated, the findings at endoscopic US and those at pathologic examination were concordant in 46 of 50 patients (92%), and the findings at dynamic CT and those at pathologic examination, in 14 of 33 patients (42%) (P less than .00042). Evaluation of regional lymph node metastases showed a concordance of 78% with endoscopic US and 48% with dynamic CT (P less than .038). Overall determination of stage with both dynamic CT and endoscopic US showed a concordance of 73%, compared with a concordance of 45% for dynamic CT alone (P less than .028).

Endoscopic Evaluation of Transabdominal Sonographically Suggested Gastric Carcinoma

Transabdominal ultrasonography (TAS) is a widely used imaging modality for large variety of abdominal complaints. But indeed it has limited values for diagnosis of gastrointestinal diseases. Literatures on the value of transabdominal ultrasonography on diagnosis and preoperative staging of gastric cancer are sparse. So the aim of this study is to assess the accuracy and limitations of ultrasonography for diagnosis and detection of spreading of gastric carcinoma.Fifty eight sonographically diagnosed patients were included in this study. UGI endoscopy was done in all patients. Five patients were excluded from study because of negative biopsy though endoscopy revealed suspicious lesion. The accuracy of conventional transabdominal sonography of fluid filled stomach was evaluated for diagnosis of gastric carcinoma as compared to endoscopy. The age range was between 14-75 years with mean age 43.5 years (SD ±14.2). The maximum numbers of patients (28.3%) were within the age group 40-49 years. The male and female ratio was 1.2:1. Fifty (94.3%) out of 53 patients of sonographically detectable gastric carcinoma actually have true malignancy proven by endoscopic biopsy and 3 (5.6%) were endoscopically normal & no biopsy was taken. Distal gastric carcinoma has been more precisely located than proximal by sonography. Besides this sonography provided an estimate of extragastric spread of tumour (34%) which is not possible by endoscopy. So in conclusion transabdominal sonography is an useful supportive modality for diagnosis and pre-operative assessment of exogastric spread of gastric cancer and indeed a supplementary diagnostic procedure to endoscopy. doi: 10.3329/taj.v20i1.3089 TAJ 2007; 20(1): 48-51