Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer |
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Authors: | Satoru Nakagawa Atsushi Nashimoto Hiroshi Yabusaki |
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Institution: | (1) The Division of Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Niigata 951-8566, Japan |
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Abstract: | Background More accurate preoperative staging is necessary to determine the treatment strategy for locally advanced gastric cancer. Laparoscopy
has been suggested as an appropriate staging modality. The aim of this study was to clarify the role of staging laparoscopy
in patients with locally advanced gastric cancer.
Methods One hundred patients with primary gastric adenocarcinoma underwent laparoscopy with peritoneal lavage cytology. The disease
stages determined were compared with those obtained by conventional methods.
Results The disease stages were corrected after laparoscopy for 47 of the 100 patients (47%), with downstaging in 3 (3.0%) and upstaging
in 44 (44%). Peritoneal deposits were found in 7 patients with peritoneal dissemination diagnosed by conventional examination.
An unsuspected peritoneal deposit was found in 21 of 93 patients (22.6%), and unsuspected free cancer cells without deposits
were found in 27 of 93 patients (29.0%). Gastrectomy after staging laparoscopy was performed in 39 patients. Laparoscopy showed
no peritoneal deposits in any of these patients. Free cancer cells were found in 9 patients (23.1%), but 4 of these had peritoneal
deposits at operation. R0 resection was performed in 34 of the 39 patients (87.2%). Neoadjuvant chemotherapy after staging
laparoscopy was performed in 35 patients. All 35 patients underwent gastrectomy, which resulted in 27 R0 and 8 R2 resections.
Of 18 patients with positive cytology at laparoscopy, 11 had no free cancer cells at operation. Neoadjuvant chemotherapy induced
downstaging of the disease in 11 of the 18 patients with positive cytology (61.1%). Of 26 patients with massive peritoneal
deposits, 4 underwent palliative resection because of pyloric stenosis. Twenty-two patients (22.0%) were able to avoid unnecessary
laparotomy because of the staging laparoscopy.
Conclusion Staging laparoscopy with peritoneal lavage cytology is a safe, effective tool in patients with locally advanced gastric cancer,
especially in patients receiving neoadjuvant chemotherapy. |
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Keywords: | Gastric cancer Staging laparoscopy Peritoneal lavage cytology |
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