The role of pretherapeutic laparoscopy in the selection of treatment for patients with gastric carcinoma: A proposal for a laparoscopic staging system

Background. A pretherapeutic staging system to design nonoperative or neoad juvant treatments in gastric cancer is required. In this study, a simple st aging system based on laparoscopic findings to define a treatment algorithm was developed. Methods: A retrospective cohort study was conducted of 151 patients allocat ed into four stages based on laparoscopic findings. The depth of tumor inva sion and the presence of metastasis based on laparoscopic findings were use d to construct these stages. Laparoscopic findings were compared with histo pathology. Results: An excellent agreement of the laparoscopy-defined depth of invasio n and the surgical pathology standard was found (weighted kappa 0.85). The likelihood ratios for a positive and negative laparoscopic diagnosis of met astasis were 40.4 and 0.015, respectively (98.5% sensitivity, 97.6% specifi city). Those for positive and negative diagnosis of resectability were 2.6 and 0.03, respectively (98.4% sensitivity, 62% specificity). The laparoscop ic stages presented significant prognostic value. Two-year survival was 93% , 69%, 60%, and 17%, respectively. Surgical resection was possible in 100%, 100%, 49%, and 12% respectively. Conclusions-The proposed laparoscopic staging system is a simple and reprod ucible way for selection of a suitable therapy. It allows for adequate stra tification of the main risk factors in the setting of clinical trials evalu ating preoperative treatments.