Staging by immediate preoperative laparoscopy in adenocarcinoma of the distal esophagus and cardia

Accurate preoperative staging of adenocarcinoma of the esophagus and cardia is critical to select the proper treatment in the individual patients, i.e., resection, neoadjuvant therapy, or endoscopic palliation. Aim of this study was to assess the role of laparoscopy in detecting intra-abdominal metastatic spread in patients with adenocarcinoma of the esophagus and cardia. Between November 1995 and May 1998, 45 patients with histologically-proven adenocarcinoma of the cardia--without any previous treatment--and negative or inconclusive findings at computed tomography (CT) and ultrasonography (US) underwent staging laparoscopy at the same session of the planned surgical resection. The mean operative time of the procedure was 25 minutes (range 15-55 min). Laparoscopy led to change the therapeutic approach in five patients (11.1%): three patients with peritoneal carcinomatosis and one with a liver metastasis undetected at preoperative imaging studies did not have resection; conversely, one individual with liver hemangioma simulating a metastatic mass at CT underwent esophagogastric resection. In patients with adenocarcinoma of the esophagus and cardia, laparoscopy is useful to increase accuracy of detection of metastases; when performed as the first step of a planed resection, it avoids unnecessary laparotomies and does not increase the complexity of preoperative evaluation.