Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus

Molloy, R. G.; McCourtney, J. S.; Anderson, Judith

doi:10.1002/bjs.1800820322

Cited by 94 publications

(34 citation statements)

References 15 publications

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“…Routine staging laparoscopy is now advocated following CT and endoluminal ultrasound prior to consideration of radical surgery in patients with gastric cancer [4,[19][20][21]. Nevertheless, the role of laparoscopy as a routine staging strategy remains controversial, and none of the above reports have assessed the true statistical accuracy of laparoscopy when compared with CT and the final histopathological stages of patients' tumors.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

et al. 2003

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Despite the introduction of open access gastroscopy, as many as one in three British patients continue to present with advanced disease that is incurable by means of surgery [2,3]. Thorough and accurate staging of patients is of paramount importance in the selection of patients for whom surgery could be potentially curative [4].The recent large regional audit of esophagogastric cancer in Wales revealed that many surgeons continue to undertake small caseloads; staging laparoscopy was performed in 16% of cases; and no fewer than 23% of patients underwent open-and-close operations [3]. Staging protocols for patients with gastric cancer vary, not only from hospital to hospital within the United Kingdom, but from east to west worldwide. While computed tomography (CT) remains the most widely used imaging technique for the preoperative staging of patients with gastric cancer, this modality is limited in its ability to detect local invasion and lymph node metastases [5][6][7][8]. Moreover, we have already shown that specialized radiological support improves the perceived preoperative stage of gastric cancer and reduces the rate of open-and-shut laparotomy [9].Although routine laparoscopy is now advocated in the preoperative staging of gastric cancer [4], there are discrepant results in the literature as to the clinical value of this procedure [10]. The aims of this study therefore, were to compare the perceived preoperative stage of gastric cancer as determined by CT and laparoscopy, and to compare this perceived stage with the final true histopathological stage. It was our hypothesis that laparoscopy would improve the accuracy of our preoperative staging process. Patients and methods Between

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Section: Discussionmentioning

confidence: 99%

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

et al. 2003

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“…Furthermore, as EUS is not an Received 14 August 1997Revised 16 February 1998Accepted 5 March 1998 Correspondence to: AC Kole appropriate method for assessing nodal involvement at the coeliac axis, metastases in the right liver lobe and peritoneal dissemination -although some improvement can be obtained with fine-needle aspiration cytology during EUS (Tio et al, 1989;Lightdale, 1992;Dittler and Siewer, 1993) -explorative laparoscopy or laparotomy to assess metastatic disease and to estimate the possibility of resecting the tumour with curative intent usually remains necessary. Laparoscopy fails to detect locally irresectable or metastatic disease in 20% of patients, whereas in approximately 30% there are no therapeutic options at explorative laparotomy (Molloy et al, 1995) Positron emission tomography (PET) offers the possibility of investigating the glucose metabolism of tumours in vivo, with the use of the radiopharmaceutical [18F]fluoro-2-deoxy-D-glucose (FDG). Tumours with a high glucose metabolism such as oesophageal cancer, also have a high FDG consumption (Yasuda et al, 1995).…”

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confidence: 99%

Positron emission tomography for staging of oesophageal and gastroesophageal malignancy

Kole

Plukker²,

Nieweg³

et al. 1998

Br J Cancer

166

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Summary Positron emission tomography (PET) with [18F]-fluoro-2-deoXy-D-glucose (FDG) was prospectively investigated as a means of detecting metastatic disease in patients with oesophageal tumours and compared with computerized tomography (CT), with the surgical findings as a gold standard. Twenty-six patients with a malignant tumour of the oesophagus or gastroesophageal junction underwent CT and PET of the chest and the abdomen. Seven patients underwent laparoscopy to establish resectability. Fifteen patients underwent laparotomy without prior laparoscopy. Four patients did not undergo surgery. The primary tumour was visualized in 81% of patients with CT and in 96% with PET. Neither CT nor PET were suited to assess the extent of wall invasion. Surgically assessed nodal status corresponded in 62% with CT and in 90% with PET. Distant metastases were found in five patients with CT and in eight with PET. The diagnostic accuracy of CT in determining resectability was 65% and for PET 88%. For CT and PET together this was 92%. The present study indicates that FDG-PET can be of importance for staging patients with oesophageal tumours. PET has a higher sensitivity for nodal and distant metastases and a higher accuracy for determining respectability than CT. PET and CT together would have decreased ill-advised surgery by 90%.

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“…MIS staging has a role in patients with potentially resectable esophageal cancer without distant metastases detected by conventional imaging. For these patients, laparoscopy can be used to identify small liver surface and peritoneal metastases while thoracoscopy can assess invasion of local structures, such as the aorta or pleura (26,28,(32)(33)(34)(35). In an interesting study, Luketich and colleagues prospectively studied the staging accuracy of PET and MIS staging in patients with potentially resectable disease.…”

Section: Benefits Of Minimally Invasive Stagingmentioning

confidence: 99%

Minimally invasive staging of esophageal cancer

Mehta

Bianco

Awais

et al. 2017

Ann. Cardiothorac. Surg.

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Esophageal cancer is one of the most common malignancies in the world today and the sixth-leading cause of cancer-related mortality. Accurate preoperative staging of esophageal cancer is imperative to the selection of appropriate treatments. Patients with esophageal carcinomas typically undergo a multimodality staging process including noninvasive imaging techniques, such as computed tomography (CT) and positron emission tomography (PET), as well as endoscopic ultrasound (EUS), which is slightly more invasive.Minimally invasive surgical staging, with laparoscopy, occasionally in combination with video-assisted thoracoscopy, is used in the staging process at select institutions and has been shown to be more accurate than noninvasive staging modalities. Two major advantages of minimally invasive surgical staging over conventional techniques are the improved assessment of locoregional disease and enhanced identification of distant metastases. These advantages decrease the likelihood that the patient will undergo a nontherapeutic laparotomy. Currently, no clear consensus exists regarding which patients with esophageal cancer would benefit most from the addition of minimally invasive surgical staging. We have, however, found that minimally invasive surgical staging with laparoscopy is particularly valuable in detection of occult distant metastases. In this article, we summarize the staging modalities for esophageal cancer including minimally invasive surgical staging.

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Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus

Cited by 94 publications

References 15 publications

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

Positron emission tomography for staging of oesophageal and gastroesophageal malignancy

Minimally invasive staging of esophageal cancer

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