Staging Laparoscopy for Gastric Cancer

Abstract

Surgical resection remains the only potentially curative treatment of patients with gastric cancer. Evaluation of surgery and other treatments depends on accurate staging of the disease. The objective of the study was to compare staging laparoscopy with ultrasonography, endoscopic ultrasound, computed tomography, and histology for serosal infiltration, lymph node metastasis, peritoneal seeding, and hepatic metastasis. Diagnostic laparoscopy was carried out in 48 patients. Prelaparoscopic staging in all cases included upper gastrointestinal endoscopy and biopsies followed by endosonography, ultrasound, and computed tomography. Preoperative combined examination using CT and laparoscopy was superior when compared with each modality alone or the combinations of the other tests. The present study showed that preoperative evaluation of patients with laparoscopy is superior to all other diagnostic tests. We also found that laparoscopy and computed tomography were better in accurately assessing the serosal infiltration, peritoneal seeding, and hepatic metastases, which thus allows the surgeon to choose more effective treatment modality.

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

“…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.…”

(Neo)adjuvant Strategies of Advanced Gastric Carcinoma: Time for a Change?

“…In this regard, endosonography with its high sensitivity in the assessment of tumor size and local lymph node involvement has increasingly been accepted for preoperative staging [42][43][44] . In addition, (mini)laparoscopy allows detection of peritoneal carcinosis, which is being found in ϳ 20-30% of gastric cancer patients at primary diagnosis [45][46][47][48] . As the position emission tomography scan has been additionally proven to effectively predict the clinical response in esophageal and gastric cancer, such diagnostic procedures will allow better allocations and adjustments for an individualized and optimized treatment strategy.…”

Laparoscopic resection of submucosal tumor on posterior wall of gastric fundus

“…For most benign gastric submucosal tumors, the range of excision is too large and the procedure is too invasive [27][28][29][30][31] . Laparoscopic wedge resection of stomachs is the most commonly seen procedure for submucosal tumors of gastric fundus [31][32][33][34] . The tumor on the anterior wall of fundus is easy to excise with Endo GIA [20] .…”