ACCURACY OF LAPAROSCOPIC ULTRASONOGRAPHY IN THE STAGING OF UPPER GASTROINTESTINAL MALIGNANCY

Laparoscopic ultrasonographic staging was compared prospectively with conventional computed tomography (CT) and ultrasonographic staging of 24 lower-third oesophageal tumours and 20 gastric malignancies. Follow ing laparoscopic ultrasonography, seven patients regarded as being res ectable after conventional imaging were excluded from surgical explora tion because of ascites with peritoneal deposits (four patients), live r metastases (one), advanced local disease (one) and poor tolerance of general anaesthesia (one). Preoperative T and N stages were compared with the pathological staging following resection in 34 patients. Lapa roscopic ultrasonography was significantly more accurate than conventi onal CT and ultrasonography in assessment of the primary tumour (91 ve rsus 64 per cent, P <0.01) and nodal status (91 versus 62 per cent, P< 0.05). The addition of laparoscopic ultrasonography to conventional pr ocedures for staging upper gastrointestinal malignancy improved the ov erall accuracy of staging. Although this may have future implications for the selection of patients for multimodality treatment, management decisions are currently based on laparoscopic findings, which in this study resulted in a resection rate of 97 per cent.