A PROSPECTIVE COMPARISON OF LAPAROSCOPY AND IMAGING IN THE STAGING OFESOPHAGOGASTRIC CANCER BEFORE SURGERY

Objective: To carry out a prospective comparison of laparoscopy and co mbined imaging (CT and ultrasound) in the preoperative staging of dist al esophageal and gastric cancer in patients who were selected for sur gery. Methods: Patients with clinically overt metastases or a contrain dication to major surgery were excluded. One hundred and forty-five pa tients underwent chest radiography, CT of mediastinum and abdomen, and ultrasonography of abdomen and laparoscopy. The primary diagnoses wer e adenocarcinoma of the esophagogastric region in 110 cases, squamous cell carcinoma of the distal esophagus in 30 patients, and five miscel laneous. Results: Thirty nine (27%) patients had metastatic disease ou tside the potential field of resection. Metastases were detected preop eratively by laparoscopy in 30 patients (sensitivity 77%) and by combi ned imaging in 15 (sensitivity 38%) (p < 0.01). Twenty four patients w ith adenocarcinoma had metastases to the peritoneal cavity, which were detected preoperatively by laparoscopy in 23 (sensitivity 96%) and by combined imaging in five (sensitivity 21%) (p < 0.01). Peritoneal met astases were not seen in patients with squamous cell carcinoma. Fiftee n patients had hepatic metastases, which were detected preoperatively by laparoscopy in nine (sensitivity 60%) and by combined imaging in se ven (sensitivity 47%). Laparoscopy was more sensitive than combined im aging in detecting metastases in patients with adenocarcinoma [laparos copy 28, combined imaging 10 (p < 0.01)]. Conclusion: Addition of lapa roscopy to the staging protocol prevented unbeneficial thoraco-abdomin al exploration in 20 patients with adenocarcinoma. Thus, laparoscopy s hould be used in the assessment of patients with adenocarcinoma of the esophagogastric region before performing excisional surgery.