LAPAROSCOPY AND LAPAROSCOPIC ULTRASONOGRAPHY IN STAGING OF CARCINOMA OF THE ESOPHAGUS AND GASTRIC CARDIA

BACKGROUND: The objective of this prospective study was to assess the contribution of laparoscopy combined with laparoscopic ultrasonogaphy (LLU) in the preoperative staging of patients with carcinoma of the es ophagus and cardia. STUDY DESIGN: Preoperative LLU was performed in 56 patients who were selected for curative resection of carcinoma of the esophagus (n = 38) or gastric cardia with involvement of the distal e sophagus (n = 18) after routine preoperative workup. During LLU, the p eritoneal cavity was scrutinized for metastatic disease, and ultrasono graphy of the liver and celiac axis was performed. In all patients wit hout histologically proven metastases, laparotomy was then performed. RESULTS: The morbidity rate of the procedure was 3.5 percent (two supe rficial wound infections). In three (5 percent) of the 56 patients, la parotomy was excluded by the presence of intra-abdominal metastases. I n three other patients, laparotomy was necessary to confirm the suspec ted hepatic or peritoneal metastases, or both, because histologic proo f was not obtained at laparoscopy. In one patient, LLU failed to detec t a small hepatic metastasis in segment VII. The preoperative stage wa s altered by laparoscopy in nine (17 percent) patients (M(1) in six, T -4 in three). Laparotomy was avoided in two (11 percent) and the preop erative stage changed in seven patients (41 percent), all of whom had carcinoma of the gastric cardia, as occurred in one (3 percent) and tw o (6 percent) patients with middle and distal carcinoma of the esophag us, respectively. CONCLUSIONS: Preoperative staging by LLU is of Littl e value in patients with carcinoma of the middle and lower esophagus. The probable role of LLU in the staging of patients with carcinomas of the gastric cardia remains to be confirmed in larger series.