VIDEO-LAPAROSCOPIC STAGING OF GASTRIC-CANCER - A PROSPECTIVE MULTICENTER COMPARISON WITH NONINVASIVE TECHNIQUES

Background: The high proportion of gastric carcinomas present in an un resectable stage, together with the emergence of multimodal treatments , increases the usefulness of objective staging methods that avoid unn ecessary laparotomies. Methods: A prospective evaluation of the accura cy of laparoscopy in the staging of 71 patients with gastric adenocarc inoma is presented. Serosal infiltration, retroperitoneal fixation, me tastasis to lymph nodes, peritoneal and liver metastasis, and ascites were determined in the staging workup, Sensitivity, specificity, and p redictive values were calculated and compared with those obtained with ultrasonography (US) and computed tomography (CT). Results: The diagn ostic accuracy of laparoscopy in the determination of resectability wa s 98.6%, Consequently, over 40% of patients were spared unnecessary la parotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes studied. Our technique permits accur ate assessment and pathologic verification of liver and the peritoneal and retroperitoneal extent of tumor invasion in the majority of patie nts. Conclusions: Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage , thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup combining im aging and minimally invasive techniques is proposed.