Laparoscopy
Selection of patients with gastric adenocarcinoma for laparoscopic staging

https://doi.org/10.1016/j.amjsurg.2005.10.015Get rights and content

Abstract

Background

To refine selection criteria for laparoscopic staging of gastric adenocarcinoma, preoperatively available clinical and radiologic factors that may predict the risk of M1 disease were investigated.

Methods

During 1993–2002, laparoscopy was performed if patients had minimal symptoms and there was no definite M1 disease at computed tomography (CT) scanning. High-quality, spiral, CT scans were reviewed in detail for 65 recent patients.

Results

Laparoscopy was conducted for 657 patients and M1 was detected in 31%. M1 was significantly more prevalent with tumor location at the gastroesophageal junction (GEJ; M1 in 42%) or whole stomach (66%), poor differentiation (36%) or age ≤70 years (34%). On spiral CT scan, lymphadenopathy ≥1 cm (49%) or T3/T4 tumors (63%) were associated with significantly higher prevalence of M1. On multivariate analyses, only tumor location (GEJ or whole stomach) and lymphadenopathy were independently significant and M1 was not detected in any patient with neither risk factor.

Conclusions

With spiral CT staging, laparoscopy may be avoided if the primary tumor is not at the GEJ or whole stomach and there is no lymphadenopathy.

Section snippets

Patients and Methods

Patients who had undergone laparoscopic staging of gastric adenocarcinoma between April 1993 and May 2002, at Memorial Sloan Kettering Cancer Center (MSKCC) were identified from a prospectively maintained database. Patients who had laparoscopy between 1993 and 1995 have been included in a previous report [1]. During this period, CT scanning of the abdomen and pelvis was routinely employed for staging. An incremental technique of CT scanning was used in the early part of the study and a spiral

Results

Between April 1993 and June 2002, 1748 patients with gastric adenocarcinoma were admitted to MSKCC and 718 (41%) patients underwent a staging laparoscopy. Of these, 657 patients were eligible for inclusion in this study. There were 371 (56%) men and 286 (44%) women, median age 65 years (range 26 to 92). The primary tumor was located at the gastroesophageal junction (GEJ; 105, 16%), proximal stomach (134, 21%), gastric body (178, 27%), antrum (187, 28%) or whole stomach (carcinoma that involved

Comments

Our group has previously recommended laparoscopic staging for patients who are candidates for potentially curative resection of gastric adenocarcinoma and do not have clinically significant obstruction or bleeding [1]. Using such selection criteria, 657 patients underwent staging laparoscopy at MSKCC over a 10-year period and were eligible for inclusion in this study. M1 disease was detected at laparoscopy in 23% of patients. Another 9% of patients had a “false-negative” result by laparoscopy

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