Staging by immediate pre-operative laparoscopy for adenocarcinoma of the oesophagus and cardia.

Accurate preoperative staging of adenocarcinoma of the esophagus and cardia is critical to select the proper treatment in the individual patients, i.e ., resection, neoadjuvant therapy, or endoscopic palliation. Aim of this st udy was to assess the role of laparoscopy in detecting intra-abdominal meta static spread in patients with adenocarcinoma of the esophagus and cardia. Between November 1995 and May 1998, 45 patients with histologically-proven adenocarcinoma of the cardia - without any previous treatment - and negativ e or inconclusive findings at computed tomography (CT) and ultrasonography (US) underwent staging laparoscopy at the same session of the planned surgi cal resection. The mean operative time of the procedure was 25 minutes (ran ge 15-55 min). Laparoscopy led to change the therapeutic approach in five p atients (11.1%) : three patients with peritoneal carcinomatosis and one wit h a liver metastasis undetected at preoperative imaging studies did not hav e resection; conversely, one individual with liver hemangioma simulating a metastatic mass at CT underwent esophagogastric resection. In patients with adenocarcinoma of the esophagus and cardia, laparoscopy is useful to incre ase accuracy of detection of metastases; when performed as the first step o f a planed resection, it avoids unnecessary laparotomies and does not incre ase the complexity of preoperative evaluation.