Yano M, Tsujinaka T, Shiozaki H, Inoue M, Sekimoto M, Doki Y, Takiguchi S, Imamura H, Taniguchi M, Monden M
Department of Surgery II, Osaka University Medical School, Japan.
World J Surg. 2000 Sep;24(9):1130-5; discussion 1135-6. doi: 10.1007/s002680010183.
More accurate preoperative staging is necessary to determine the treatment strategy for locally advanced gastric cancer. Thirty-two patients with T3 or T4 gastric cancer expected to undergo curative resection based on conventional examinations underwent staging laparoscopy. The disease stages determined were compared with those obtained by conventional methods. The discrepancy rate of disease staging was 16 of 32 (50.0%), with down-staging in 5 of 32 (15.6%) and up-staging in 11 of 32 (34.4%). Of the 32 patients, 13 (40.6%) were found to have unsuspected peritoneal dissemination. The positive predictive value for peritoneal metastasis by staging laparoscopy was 100%, whereas the negative predictive value was 89% (17/19). The accuracy rate was 94%. After laparoscopy, 15 of the 32 (46.9%) were diagnosed as candidates for curative resection. Of these 15 patients who underwent surgery, 13 (86.7%) underwent curative resection (1 R0 and 12 R1); the remaining two underwent R2 resection because of peritoneal metastasis that was undetected by staging laparoscopy. Patients with tumors judged noncurable by laparoscopy (n = 11) received neoadjuvant chemotherapy. In 7 of the 11 cases, salvage surgery was done (one R0, three R1, three R2 resections). A second staging laparoscopy was performed in four cases to determine the indication for salvage surgery. Three of the four were judged to be curable and underwent curative resection. Staging laparoscopy is an effective tool for detecting unsuspected peritoneal metastasis, and it can increase the curative resection rate and decrease unnecessary laparotomy for advanced gastric cancer. Second-look laparoscopy enables accurate assessment of the chemotherapeutic response, which can help in decisions about salvage surgery.
为确定局部进展期胃癌的治疗策略，需要更准确的术前分期。32例根据传统检查预计可接受根治性切除的T3或T4期胃癌患者接受了分期腹腔镜检查。将确定的疾病分期与通过传统方法获得的分期进行比较。疾病分期的差异率为32例中的16例（50.0%），其中降期32例中的5例（15.6%），升期32例中的11例（34.4%）。32例患者中，13例（40.6%）被发现有意外的腹膜播散。分期腹腔镜检查对腹膜转移的阳性预测值为100%，而阴性预测值为89%（17/19）。准确率为94%。腹腔镜检查后，32例中的15例（46.9%）被诊断为根治性切除的候选者。在这15例接受手术的患者中，13例（86.7%）接受了根治性切除（1例R0和12例R1）；其余2例因分期腹腔镜检查未发现的腹膜转移而接受了R2切除。经腹腔镜检查判断为不可治愈的肿瘤患者（n = 11）接受了新辅助化疗。11例中的7例进行了挽救性手术（1例R0、3例R1、3例R2切除）。4例患者进行了第二次分期腹腔镜检查以确定挽救性手术的指征。4例中的3例被判断为可治愈并接受了根治性切除。分期腹腔镜检查是检测意外腹膜转移的有效工具，它可以提高晚期胃癌的根治性切除率并减少不必要的剖腹手术。二次腹腔镜检查能够准确评估化疗反应，这有助于决定挽救性手术。
