AIM:The role of laparoscopy in staging of gastric cancer is widely accepted; however, in Malaysia its usage has been limited. Patients can be classified as resectable or unresectable, which helps in avoiding an unwanted laparotomy and the morbidities associated with it. The aim of this study was to assess the value of laparoscopy in staging of gastric cancer in comparison with CT scan.MATERIALS AND METHODS:Patients with carcinoma of the stomach after a complete preoperative work-up underwent laparoscopy prior to surgical exploration. TNM staging was used to compare laparoscopy with CT, with the histopathological report used as the gold standard.RESULTS:Forty cases were included in this study. The sensitivity of laparoscopy for T3 tumours appears to be significant when compared to that of CT. Laparoscopy detected 90.3% of the cases as against the 58% detected with CT. There was not much difference in the N factor. With regard to M factor, the sensitivity was 100% for laparoscopy in comparison with CT.CONCLUSIONS:Laparoscopy has been shown to be sensitive in detecting metastasis in gastric cancer in comparison to CT, thus helping in avoiding unwanted laparotomy and thus providing a more systemic approach in managing gastric cancers.

Five topics were presented in this symposium. The fi rst part of the morning session was on the epidemiology of gastric cancer, with a presentation from Kee-Seng Chia, NUS. He emphasized the decline in the incidence of gastric cancer worldwide and the rising trend of cardial cancer in Western countries. He also highlighted the central role of Helicobacter pylori infection in noncardia gastric cancer and, in contrast, the reduced risks of gastric cardia cancer associated with H. pylori seropositivity. Yoshiaki Ito, from the Oncology Research Institute, Singapore, spoke about carcinogenesis and molecular biology. He explained the relationship between RUNX3, a gastric tumor suppressor gene, and the tumorigenicity and intestinalization of gastric epithelial cells [1]. Next, Soo-Chin Lee, an oncologist from the NUH, Singapore, gave a concise review of gastric cancer genetics. She highlighted several hereditary gastric cancer syndromes and the high incidence of stomach cancer in Asian families with hereditary nonpolyposis colon cancer (HNPCC). She recommended that gastric cancer surveillance should be considered for Asian HNPCC kindreds. Finally, she summarized the current available genetic tests for identifying high-risk families for gastric cancer. Enders Ng, from the Chinese University of Hong Kong, discussed the role of H. pylori in gastric carcinogenesis. He highlighted a few randomized controlled trial studies regarding the impact of H. pylori eradication on gastric cancer carcinogenesis [2,3]. The studies showed that eradication retarded the progression of atrophy and intestinal metaplasia in the stomach, but did not reverse either the intestinal metaplasia or glandular atrophy. The last speaker, Patrick Tan, from the Genome Institute of Singapore, talked about the application of tissue microarrays in gastric cancer research [4]. He discussed patterns of gene expression correlated to gastric cancer regulation that may predict survival. He gave as an example that the expression of the phospholipase A2 Group IIA gene in gastric cancer was associated with prolonged survival.