Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia.

J. Hulscher, E. J. Nieveen van Dijkum, L. de Wit, O. V. van Delden, J. van Lanschot, H. Obertop, D. Gouma
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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.
腹腔镜和超声在贲门癌分期中的应用。
目的探讨诊断性腹腔镜和腹腔镜超声检查在贲门癌累及食管远端分期中的作用。设计回顾性连续病例系列。三级护理中心,荷兰。研究对象48例(34男14女,中位年龄63岁,范围39-84岁)出现贲门肿瘤累及食管远端,非侵入性分期未显示不可切除的局部疾病或远处转移的患者。干预措施除腹腔镜和腹腔镜超声检查外,对潜在切除区域外的所有疑似病变进行活检。主要结果测量结果显示无需剖腹探查的患者数量。结果无腹腔镜相关并发症发生。调查显示11例患者有远处转移(经组织学证实)(23%,95%可信区间(CI) 16 - 30)。这些患者有非手术缓解。其中7例经腹腔镜检查,其余4例经腹腔镜超声检查。在3例经腹腔镜检查发现远处转移的患者中,超声检查被省略。另外3例患者有可疑病变,但未得到组织学证实。然而,这些病变在剖腹手术时被证明是癌性的。另外一名患者有腹腔内转移,但腹腔镜超声检查未发现。结论在48例贲门癌患者中,有23%的患者在超声内镜下安全发现了常规分期未发现的转移灶。因此,对贲门癌累及食管远端患者的标准分期程序中应增加此项调查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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