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Staging Laparoscopy in Carcinoma of Stomach: A Comparison with CECT Staging

DOI: 10.1155/2013/674965

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Background. aim of this study was to compare the role of diagnostic laparoscopy and contrast enhanced computed tomography (CECT) of abdomen in the staging of stomach carcinoma. Methods. This was a prospective study conducted in a tertiary care hospital over a period of two years and included 50 patients of endoscopy and biopsy proven stomach carcinoma that were found to be operable on CECT. Diagnostic laparoscopy was performed in all patients before proceeding to a formal laparotomy. Results. Metastasis was detected at diagnostic laparoscopy in 14 (28%) patients. CECT correctly identified the T stage in 22 (61%) patients. Overall accuracy of CECT for T staging was 74% with a a sensitivity of 65% and a specificity of 79%. Laparoscopy correctly identified the T stage in 26 (72%) patients. Overall accuracy of laparoscopy for T staging was 81% with a sensitivity of 76% and specificity of 86%. the most common N stage on CECT was N0 (50%). CECT correctly identified the N stage in 26 (72%) patients. Overall accuracy of CECT for N staging was 86% with a sensitivity of 50% and a specificity of 90%. the most common N stage on laparoscopy was N0 and N2 (42% each). Laparoscopy correctly identified the N stage in 27 (75%) patients. Overall accuracy of Laparoscopy for N staging was 88% with a sensitivity of 53% and specificity of 91%. Conclusion. Laparoscopy is a valuable technique in staging of stomach carcinoma and has an important role in the detection of intra-abdominal metastasis missed by CECT. 1. Introduction Gastric cancer remains one of the most common causes of death from cancer worldwide, especially in our part of the world. In Kashmir, the incidence rates for gastric cancer have been estimated at 36.7/100000 per year in men and 9.9/100000 per annum in women, respectively [1]. As the multidisciplinary management of gastrointestinal cancer has evolved over the last decade, an accurate extent of disease workup has become essential for treatment planning. Even after a thorough radiological workup, many patients with stomach carcinoma are diagnosed as unresectable or metastatic on exploratory laparotomy. For the subgroup of patients who do not require palliation, exploration confers little benefit and may, on the contrary, be associated with significant morbidity and mortality [2]. Since the introduction of contrast enhanced computed tomography (CECT) scan some 30 years back, the staging workup of gastric carcinoma has underwent a boom [3–5]. CECT is used preoperatively primarily to determine the stage and extragastric spread of the carcinoma but has the

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