Staging laparoscopy in gastric cancer. Accuracy and impact on therapy.

BACKGROUND Surgical therapy remains the most effective treatment modality in gastric cancer. The importance of multimodal treatment for advanced gastric cancer has contributed to the development of more accurate preoperative staging strategies. We examined the diagnostic accuracy of staging laparoscopy (SL) for abdominal metastases and the predictive value of SL for tumor resectability. MATERIAL AND METHOD This is a prospective, cohort, observational study of 98 patients with primary gastric adenocarcinoma admitted at a tertiary referral hospital over a three year period. Extended SL, laparoscopic ultrasonography and peritoneal cytology were performed in 45 patients with gastric cancer without distant metastases on pre-therapeutic imaging staging. Of the 45 patients, 17 (37.8%) had distant metastases on SL and were offered palliative therapy and/or supportive care. Open laparotomy and gastrectomy was performed in the patients without distant metastases or with uncertain resectability on SL. RESULTS An unnecessary laparotomy was avoided in 17 (37.8%) patients. The overall SL sensitivity for distant metastases was 89%, specificity 100% and diagnostic accuracy 95.5%. The sensitivity for lymph node metastases was 54.5%, the specificity 100% and the diagnostic accuracy 64.3%. The SL positive predictive value for resectability was 96% and the negative predictive value was 50%. The morbidity of SL was 2.2% and the mortality 0. CONCLUSION Staging laparoscopy is a safe and effective staging modality in patients with gastric carcinoma. It avoids unnecessary laparotomies in a significant number of patients and should be mandatory if neoadjuvant treatment is planned.