Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia

Objective: To investigate the role of diagnostic laparoscopy and laparoscop ic ultrasonography in the staging of carcinoma of the gastric cardia that i s involving the distal oesophagus. Design: Retrospective consecutive case series. Setting: Tertiary care centre, The Netherlands. Subjects: 48 patients (34 men and 14 women, median age 63 years, range 39-8 4) who presented with tumours of the gastric cardia that involved the dista l oesophagus and in whom non-invasive staging had not shown unresectable lo coregional disease or distant metastases. Interventions: In addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection. Main outcome measures: Number of patients in whom the findings obviated the need for exploratory laparotomy. Results: There were no complications related to the laparoscopy. The invest igation showed distant metastases (which were histologically verified) in 1 1 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparo scopic ultrasonography showed the other four. In three patients whose dista nt metastases had already been identified by laparoscopy, ultrasonography w as omitted. Three additional patients had suspect lesions, but these were n ot confirmed histologically. However, these lesions were shown to be cancer ous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography. Conclusions: Laparoscopy with ultrasonography safely detected metastases th at had not been shown by conventional staging investigations in 23% of 48 p atients with carcinoma of the gastric cardia. The investigation should ther efore be added to the standard staging procedures in patients with carcinom a of the gastric cardia that is involving the distal oesophagus.