J. Hulscher, E. J. Nieveen van Dijkum, L. de Wit, O. V. van Delden, J. van Lanschot, H. Obertop, D. Gouma
{"title":"Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia.","authors":"J. Hulscher, E. J. Nieveen van Dijkum, L. de Wit, O. V. van Delden, J. van Lanschot, H. Obertop, D. Gouma","doi":"10.1097/00042737-199912000-00271","DOIUrl":null,"url":null,"abstract":"OBJECTIVE\nTo investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus.\n\n\nDESIGN\nRetrospective consecutive case series.\n\n\nSETTING\nTertiary care centre, The Netherlands.\n\n\nSUBJECTS\n48 patients (34 men and 14 women, median age 63 years, range 39-84) who presented with tumours of the gastric cardia that involved the distal oesophagus and in whom non-invasive staging had not shown unresectable locoregional disease or distant metastases.\n\n\nINTERVENTIONS\nIn addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection.\n\n\nMAIN OUTCOME MEASURES\nNumber of patients in whom the findings obviated the need for exploratory laparotomy.\n\n\nRESULTS\nThere were no complications related to the laparoscopy. The investigation showed distant metastases (which were histologically verified) in 11 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparoscopic ultrasonography showed the other four. In three patients whose distant metastases had already been identified by laparoscopy, ultrasonography was omitted. Three additional patients had suspect lesions, but these were not confirmed histologically. However, these lesions were shown to be cancerous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography.\n\n\nCONCLUSIONS\nLaparoscopy with ultrasonography safely detected metastases that had not been shown by conventional staging investigations in 23% of 48 patients with carcinoma of the gastric cardia. The investigation should therefore be added to the standard staging procedures in patients with carcinoma of the gastric cardia that is involving the distal oesophagus.","PeriodicalId":22411,"journal":{"name":"The European journal of surgery = Acta chirurgica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"18","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The European journal of surgery = Acta chirurgica","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/00042737-199912000-00271","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 18
Abstract
OBJECTIVE
To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus.
DESIGN
Retrospective consecutive case series.
SETTING
Tertiary care centre, The Netherlands.
SUBJECTS
48 patients (34 men and 14 women, median age 63 years, range 39-84) who presented with tumours of the gastric cardia that involved the distal oesophagus and in whom non-invasive staging had not shown unresectable locoregional disease or distant metastases.
INTERVENTIONS
In addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection.
MAIN OUTCOME MEASURES
Number of patients in whom the findings obviated the need for exploratory laparotomy.
RESULTS
There were no complications related to the laparoscopy. The investigation showed distant metastases (which were histologically verified) in 11 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparoscopic ultrasonography showed the other four. In three patients whose distant metastases had already been identified by laparoscopy, ultrasonography was omitted. Three additional patients had suspect lesions, but these were not confirmed histologically. However, these lesions were shown to be cancerous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography.
CONCLUSIONS
Laparoscopy with ultrasonography safely detected metastases that had not been shown by conventional staging investigations in 23% of 48 patients with carcinoma of the gastric cardia. The investigation should therefore be added to the standard staging procedures in patients with carcinoma of the gastric cardia that is involving the distal oesophagus.