Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

Authors

  • Abhinay Indrakumar Department of surgical oncology, Vydehi Institute of Medical Science, Whitefield, Bangalore-560066, Karnataka, India
  • Ganesh S. Mandakulutur Department of surgical oncology, Vydehi Institute of Medical Science, Whitefield, Bangalore-560066, Karnataka, India
  • Keerthi R. Banavara Department of surgical oncology, Vydehi Institute of Medical Science, Whitefield, Bangalore-560066, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20164182

Keywords:

Gastric cancer, Staging laparoscopy, Computed tomography CT

Abstract

Background: It is estimated that 990000 new gastric cancer (GC) cases occur in the world annually. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination and to determine the influence of staging laparoscopy on treatment decisions in gastric cancers.

Methods: This was a prospective study conducted in a tertiary care hospital between August 2014 and February 2016. Thirty patients out of a series of 60 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted.

Results: The strengths of agreement between the CT stage and the final histopathological stage were Kw- 0.314 (95% confidence interval [CI]; 0.03-0.66; P≥0.0001) for T stage and 0.00 (95% CI; 0.0-0.00) for M stage, compared with 0.668 (95% CI; 0.39-0.98; P≥0.0001) and 1.00 (95% CI; 1.0-1.0; P≥0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 12 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT.

Conclusions: Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT and influences treatment decision making apart from preventing unnecessary laparotomies.

References

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69-90.

Fink U. EORTC protocol 40954: randomized phase III study of preoperative chemotherapy followed by surgery versus surgery alone in locally advanced gastric cancer. Brussels: European Organization for Research on Treatment of Cancer. 1999.

Feussner H, Omote K, Fink U, Walker SJ, Siewert JR. Pretherapeutic laparoscopic staging in advanced gastric carcinoma. Endoscopy. 1999;31(5):342-47.

Japanese Research Committee on Histological Classification of Gastric Cancer, “The general rules for the gastric cancer study in surgery and pathology. II. Histological classification of gastric cancer. Jap J Surg. 1981;11:140-5.

Edge SB, Byrd DR, Compton CC. AJCC Cancer Staging Manual, Springer, New York, NY, USA, 7 edi. 2009.

Lowy AM, Mansfield PF, Leach SD, Ajani J. Laparoscopic staging for gastric cancer. Surgery. 1996;119(6):611-4.

Conlon KCP. Staging laparoscopy for gastric cancer. Annali Italiani di Chirurgia. 2001;72:33-7.

Sotiropoulos GC, Kaiser GM, Lang H. Staging laparoscopy in gastric cancer. Eur J Med Rese. 2005;10(2):88-91.

Burke EC, Karpeh MS, Conlon KC, Brennan MF. Laparoscopy in the management of gastric adenocarcinoma. Annals of Surgery. 1997;225(3):262-7.

Allum WH, Griffin SM, Watson A, Colin-Jones D. Guidelines for the management of oesophageal and gastric cancer. Gut. 2002;50(Suppl V):v1–v23.

Anderson JR. Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus. Br J Surg. 1995;82:352-4.

Hunerbein M, Rau B, Schalg PM. Laparoscopy and laparoscopic ultrasound for staging of upper gastrointestinal tumours. Eur J Surg Oncol. 1995;21:50-5.

Hulscher JB, Nieveen van Dijkum EJ, de Wit LT, van Delden OM, van Lanschot JJ, Obertop H, et al. Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia. Eur J Surg. 2000;166:862-5.

National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology 2015. Available from URL http://www.nccn.org.

Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-23.

Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for diagnostic laparoscopy. Available from: URL: http://www.sagescms.org.

Blackshaw GRJC, Barry JD, Edwards P, Allison MC, Thomas GV, Lewis WG. Laparoscopy significantly improves the perceived preoperative stage of gastric cancer. Gastric Cancer. 2003;6(4):225-9.

Asencio F, Aguilo J, Salvador JL, Villar A, De la Morena E, Ahamad M, et al. Video-laparoscopic staging of gastric cancer. A prospective multicenter comparison with noninvasive techniques. Surg Endosc. 1997;11:1153-8.

Lehnert T, Rudek B, Kienle P, Buhl K, Herfarth C. Impact of diagnostic laparoscopy on the management of gastric cancer: prospective study of 120 consecutive patients with primary gastric adenocarcinoma. Br J Surg 2002;89:471-5.

Finch MD, John TG, Garden OJ, Allan PL, Paterson- Brown S. Laparoscopic ultasonography for staging gastroesophageal cancer. Surgery 1997;121:10-7.

Downloads

Published

2016-12-16

How to Cite

Indrakumar, A., Mandakulutur, G. S., & Banavara, K. R. (2016). Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers. International Journal of Research in Medical Sciences, 4(12), 5212–5216. https://doi.org/10.18203/2320-6012.ijrms20164182

Issue

Section

Original Research Articles