IMMEDIATELY PREOPERATIVE LAPAROSCOPIC STAGING FOR GASTRIC-CANCER

Background: This ongoing study is a prospective evaluation of immediat ely preoperative video-laparoscopy compared to ultrasound/computed tom ography (US/CT) staging for gastric cancer. An analysis of the first 7 0 cases is reported. Methods: TNM staging is used to compare the US/CT findings and the laparoscopic findings with the gold standard for pat hologic findings in resected specimens. Results: In our series 47 out of 70 cases are locally advanced cancers (stages III and IV): In this subset the predictive value of laparoscopic staging is 86.4%. Laparosc opy shows an overall staging accuracy of 68.6%, compared to 32.8% for US/CT. The difference is statistically significant as regards the T fa ctor (T3: 69.7% vs 12.1%, p < 0.002; T4: 84.2% vs 42.1%, p < 0.05); as regards the M factor, laparoscopy appears the most specific method fo r detecting peritoneal seeding. Conclusions: This procedure plays a cr ucial role in determining the resectability of the tumor, thus avoidin g unnecessary laparotomies. A meticulous staging becomes mandatory whe n applying modem treatment options (e.g., neoadjuvant chemotherapy) to locally advanced cancers; in this context the use of staging laparosc opy will have a relevant impact on future treatment.