Optimal Staging for Gastric Cancer Starts With High-Resolution Computed Tomography

Abstract

Accurate preoperative staging of gastric cancer is essential, because the median survival for advanced gastric cancer is only 3 months in population studies. 1 Metastasis is most common in the liver and peritoneum and less so in the lungs, bones, and distant lymph nodes. The most commonly used staging methods are computed tomography (CT) scanning of the chest, abdomen, and pelvis with intravenous or oral contrast; endoscopic ultrasonography; 18 F-fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT); and staging laparoscopy (SL). However, for most practitioners, there is confusion whether all or 1 of these studies is needed.Probably the single best staging method for malignant conditions of the abdomen and retroperitoneum is a multiphasic, contrast-enhanced CT with thin, preferably submillimeter, axial sections from chest to pelvis. Importantly, all CT scans are not alike, and a single-phase, thick-slice CT is inadequate for staging. Surprisingly, this point is not stressed by consensus guidelines for gastric cancer. 2,3 With a high-resolution CT scan, most liver, lung, lymph node, and overt peritoneal disease will be detected, making other staging studies unnecessary.In this issue of JAMA Surgery, Gertsen et al 4 report a large (N = 394) prospective cohort study of FDG-PET/CT and SL for