LAPAROSCOPY IN THE MANAGEMENT OF GASTRIC ADENOCARCINOMA

Objective The authors determined the accuracy of laparoscopy in detect ing metastatic disease in patients with gastric adenocarcinoma. Summar y Background Data The majority of patients with gastric adenocarcinoma in the United States present with advanced disease. They are at high risk for intraabdominal metastatic spread. Methods One hundred eleven patients with gastric adenocarcinoma underwent laparoscopy at Memorial -Sloan Kettering Cancer Center from December 1991 to December 1995. Al l were judged to be free of intra-abdominal metastatic disease on preo perative computed tomographic scan imaging. Results Laparoscopic explo ration was successful in 110 of 111 patients and accurately staged 94% of the patients with respect to metastatic disease with a sensitivity of 84% and a specificity of 100%. The prevalence rate of metastatic d isease was 37%. Twenty-four patients underwent laparoscopy only and we re discharged in an average 1.4 days versus 6.5 days in patients under going exploratory laparotomy without resection (p < 0.05). No patients undergoing laparoscopy only have returned for palliative surgery. Con clusions Laparoscopy should be performed in nonobstructed, nonbleeding patients with advanced gastric cancer in the United Stales. More than one third of these patients have unsuspected metastatic disease at ti me of operation. Laparoscopy is highly accurate in detecting occult me tastases and identifies a unique population of stage IV patients who m ay benefit from newer induction chemotherapeutic approaches while avoi ding unnecessary laparotomy.