Pretherapeutic Laparoscopic Staging in Advanced Gastric Carcinoma

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Abstract
Progress in multimodal treatment has extended the management options in patients with gastric cancer [ 1 ] [ 2 ]. Evaluation of each new treatment depends on accurate staging of the tumor, associated lymph nodes, and distant metastases (the TNM classification). Endosonography is currently the most reliable nonsurgical method available for evaluating the primary tumor, with a diagnostic accuracy of over 80 % for all T stages [ 3 ]. Computed tomography (CT), conventional ultrasound, and endosonography can all be used to investigate the lymph-node status and presence of distant metastases [ 4 ] [ 5 ], although the overall diagnostic precision is significantly lower in comparison with the T stage [ 6 ]. What these tests are unable to diagnose accurately is to assess for the presence of peritoneal carcinomatosis, which is of great importance for planning therapy and assessing the prognosis in patients with advanced gastric cancer [ 7 ] [ 8 ]. Direct visualization of the abdominal cavity using laparoscopy might be able to close this diagnostic gap, particularly since recent advances now allow a more thorough examination of both the greater sac of the peritoneum and the lesser peritoneal sac (omental bursa), as well as direct ultrasound assessment of the liver and lymph nodes. The aims of this preliminary study were firstly, to evaluate the frequency of peritoneal metastases in patients with T3 and T4 gastric cancers, and secondly to assess whether detailed laparoscopy can influence treatment strategies for this disease.

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