Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

Blackshaw, Guy; Barry, Jonathan; Edwards, Paul A.W.; Allison, M. E. M.; Thomas, G. V.; Lewis, Wyn G.

doi:10.1007/s10120-003-0257-0

Cited by 64 publications

(42 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overall accuracy for T stage with laparoscopy was 82% as against 72% of CECT ( = 0.0324). Our results are similar to those of the study conducted by Blackshaw et al and D'Ugo et al 17 Laparoscopy held a small advantage over CT in assessing T stage, and a statistically significant advantage over CT in assessing the presence of peritoneal metastases and liver metastasis. The striking feature of the major published reports regarding the value of laparoscopy in staging patients with gastric cancer is the extreme variability of the results.…”

Section: Discussionsupporting

confidence: 82%

Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

Indrakumar¹,

Mandakulutur²,

Banavara³

2016

Int J Res Med Sci

View full text Add to dashboard Cite

INTRODUCTIONIt is estimated that 990000 new gastric cancer (GC) cases occur in the world annually.1 In India, the incidence rate of gastric is low compared to that in western countries, and the number of new cases is approximately 34,000. Due to the absence of a mass screening program, more than 80% of all Indian cases are discovered at an advanced stage. Despite significant improvement in preoperative tumour staging, many patients with gastric malignancies are found at exploration to be unable to undergo resection. Despite sophisticated new imaging techniques (trans-abdominal and endoscopic ultrasound, CT scan, MRI and more recently PET-CT), peritoneal tumour spread and occult liver and lymph node metastases are only detected during surgery in many patients.Staging by conventional imaging techniques is fraud with limitations and often results in under staging and unnecessary laparotomy. Computed tomography (CT) scanning is the mainstay of staging and is useful in ABSTRACT Background: It is estimated that 990000 new gastric cancer (GC) cases occur in the world annually. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination and to determine the influence of staging laparoscopy on treatment decisions in gastric cancers. Methods: This was a prospective study conducted in a tertiary care hospital between August 2014 and February 2016. Thirty patients out of a series of 60 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. Results: The strengths of agreement between the CT stage and the final histopathological stage were Kw-0.314 (95% confidence interval [CI]; 0.03-0.66; P≥0.0001) for T stage and 0.00 (95% CI; 0.0-0.00) for M stage, compared with 0.668 (95% CI; 0.39-0.98; P≥0.0001) and 1.00 (95% CI; 1.0-1.0; P≥0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 12 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT. Conclusions: Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT and influences treatment decision making apart from preventing unnecessary laparotomies.

show abstract

Section: Discussionsupporting

confidence: 82%

Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

Indrakumar¹,

Mandakulutur²,

Banavara³

2016

Int J Res Med Sci

View full text Add to dashboard Cite

show abstract

“…However, exceptions to this trend have been documented. For example, Table 2 shows that Ahn et al [23] had a high overall accuracy of 86.4%, with 88% of the patients staged as T1, while Blackshaw et al [25] had a low overall accuracy of 60%, with 85% of the patients staged as T3/T4. Consistent with the concept of being able to differentiate early versus advanced tumors, the distribution of the patient population can also have an effect on the sensitivity and specificity of identifying lymph nodes.…”

Section: Evaluation Of T Stagingmentioning

confidence: 99%

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

et al. 2011

View full text Add to dashboard Cite

Background Surgery is the fundamental curative option for gastric cancer patients. Imaging scans are routinely prescribed in an attempt to stage the disease prior to surgery. Consequently, the correlation between radiology exams and pathology is crucial for appropriate treatment planning. Methods Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 1, 2009. We calculated the accuracy, overstaging rate, understaging rate, Kappa statistic, sensitivity, and specificity for abdominal ultrasound (AUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) with respect to the gold standard (pathology). We also compared the performance of CT by detector number and image type. A meta-analysis was performed. Results For pre-operative T staging MRI scans had better performance accuracy than CT and AUS; CT scanners using C4 detectors and multi-planar reformatted (MPR) images had higher staging performances than scanners with \4 detectors and axial images only. For pre-operative N staging PET had the lowest sensitivity, but the highest specificity among modalities; CT performance did not significantly differ by detector number or addition of MPR images. For pre-operative M staging performance did not significantly differ by modality, detector number, or MPR images. Conclusions The agreement between pre-operative TNM staging by imaging scans and post-operative staging by pathology is not perfect and may affect treatment decisions. Operator dependence and heterogeneity of data may Electronic supplementary material The online version of this article

show abstract

“…The diagnosis of pre-T4 (tumor invasion of adjacent structures; SI) was assessed by CT and laparoscopic findings. Cytology and peritoneal tumor dissemination were also assessed at pretreatment staging laparoscopy [17][18][19][20] and at surgery. The cells collected by peritoneal washing were examined cytopathologically using conventional Papanicolaou and Giemsa staining.…”

Section: Endpoints and Evaluationmentioning

confidence: 99%

Phase II trial of combined treatment consisting of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for stage IV gastric cancer

et al. 2011

View full text Add to dashboard Cite

Background To improve the poor prognosis in patients with stage IV (StIV) gastric cancer (GC), we conducted a multicenter phase II study of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for StIV GC (the protocol is registered at the clinical trial site of the National Cancer Institute; KYUH-UHA-GC03-01, NCT00088816). Methods Eligibility criteria included histologically proven StIVGC. Patients received S-1 (80 mg/m 2 /day, days 1-21) plus cisplatin (60 mg/m 2 on day 8) for 2 courses. After preoperative chemotherapy (CTx), radical gastrectomy was performed. Postoperative S-1 (80 mg/m 2 /day, days 1-14) was administered every 3 weeks for 1 year. Results Fifty-one patients were enrolled and all patients were followed for more than 2 years. The 2-year overall survival and progression-free survival rates were 43.1% (95% confidence interval [CI] 29.4-56.1%) and 33.3% (95% CI 20.9-46.2%), respectively. Preoperative chemotherapy was accomplished in 44 patients (86.3%). These 44 patients underwent surgery and R0 resection was achieved in 26. The rate of R0 resection for GC with a single StIV factor (n = 24) was 79.2% and that for GC with multiple StIV factors (n = 27) was 25.9%. All patients with cancer cells in peritoneal washings (cytology [Cy] 1) alone (n = 12) became Cy0 after preoperative chemotherapy. Postoperative chemotherapy was completed in 11 patients, including 8 with Cy1 alone. No treatment-related death was recorded. Recurrences were observed in 14 patients after R0 resection. The most frequent recurrence site was the peritoneum. Patients who underwent R0 resection and those with Cy1 alone had a better survival. Conclusions This perioperative treatment was safe and feasible for StIVGC but failed to show a survival benefit. In patients with StIVGC with Cy1 alone this treatment resulted in a better prognosis.

show abstract

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

Cited by 64 publications

References 39 publications

Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

Phase II trial of combined treatment consisting of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for stage IV gastric cancer

Contact Info

Product

Resources

About