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

Abstract

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.

Evaluation of Staging Laparoscopy in Colorectal Cancer Assessment

“…This is consistent with the findings by Indrakumar et al, who assessed the role of staging laparoscopy in gastric tumors. They reported that diagnostic laparoscopy was effectively able to detect distant metastasis in 12 patients which were previously undetected on CT (7) . Another study on gastric tumors reported similar findings (8) .…”

Comparative Analysis of Computed Tomography and Laparoscopy Data in Preoperative Staging of Gastric Cancer

“…В работах S. Kakroo et al (2013 г.) [16] и A. Indrakumar et al (2013 г.) [17] также выявлено преимущество ДЛ в определении категории Т по сравнению с КТ (76-77% против 65-68%).…”

“…Причины различных заключений о преимуществах того или иного метода могут заключаться в разных подходах к группировке пациентов. Так, во всех приведенных выше зарубежных исследованиях [15][16][17] при сравнении эффективности методик авторы проводили разделение больных на группы в соответствии со степенями опухолевой инвазии T1/2, T3, T4. В нашей работе анализ проводился в группах больных со степенями опухолевой инвазии Т1-3, Т4а, Т4b.…”

“…Так, в работе S. Kakroo et al (2013 г.) показано, что ДЛ обладает незначительным преимуществом в оценке категории N по сравнению с КТ (53% против 50%) [16]. Авторы использовали разделение пациентов на группы N0, N1, N2, N3.…”

Phase 2 Multicenter Randomized Clinical Trial: Neoadjuvant Chemoradiotherapy Followed by D2 Gastrectomy and Adjuvant Chemotherapy in Patients With Locally Advanced Gastric Cancer

“…Одной из основных проблем проведения неоадъювантной терапии у больных раком желудка является недостаточная точность дооперационной (клинической) диагностики и в связи с этим назначение терапии тем больным, которым она не показана. По данным различных авторов, чувствительность КТ в определении категории Т составляет 60-65 %, а категории N -50-78 % [10,11]. В МРНЦ в последние годы последовательно изучались симптомокомплексы распространенности рака желудка, позволившие повысить точность КТ-диагностики до 80 % и более [12].…”