O'Brien M G, Fitzgerald E F, Lee G, Crowley M, Shanahan F, O'Sullivan G C
Department of Surgery, Mercy Hospital, Cork, Ireland.
Am J Gastroenterol. 1995 Dec;90(12):2191-4.
To carry out a prospective comparison of laparoscopy and combined imaging (CT and ultrasound) in the preoperative staging of distal esophageal and gastric cancer in patients who were selected for surgery.
Patients with clinically overt metastases or a contraindication to major surgery were excluded. One hundred and forty-five patients underwent chest radiography, CT of mediastinum and abdomen, and ultrasonography of abdomen and laparoscopy. The primary diagnoses were adenocarcinoma of the esophagogastric region in 110 cases, squamous cell carcinoma of the distal esophagus in 30 patients, and five miscellaneous.
Thirty nine (27%) patients had metastatic disease outside the potential field of resection. Metastases were detected preoperatively by laparoscopy in 30 patients (sensitivity 77%) and by combined imaging in 15 (sensitivity 38%) (p < 0.01). Twenty four patients with adenocarcinoma had metastases to the peritoneal cavity, which were detected preoperatively by laparoscopy in 23 (sensitivity 96%) and by combined imaging in five (sensitivity 21%) (p < 0.01). Peritoneal metastases were not seen in patients with squamous cell carcinoma. Fifteen patients had hepatic metastases, which were detected preoperatively by laparoscopy in nine (sensitivity 60%) and by combined imaging in seven (sensitivity 47%). Laparoscopy was more sensitive than combined imaging in detecting metastases in patients with adenocarcinoma [laparoscopy 28, combined imaging 10 (p < 0.01)].
Addition of laparoscopy to the staging protocol prevented unbeneficial thoraco-abdominal exploration in 20 patients with adenocarcinoma. Thus, laparoscopy should be used in the assessment of patients with adenocarcinoma of the esophagogastric region before performing excisional surgery.
对腹腔镜检查与联合成像（CT和超声）在择期手术的远端食管癌和胃癌患者术前分期中的应用进行前瞻性比较。
排除有临床明显转移或存在重大手术禁忌证的患者。145例患者接受了胸部X线摄影、纵隔和腹部CT以及腹部超声检查和腹腔镜检查。主要诊断为食管胃区域腺癌110例，远端食管癌鳞状细胞癌30例，其他5例。
39例（27%）患者在潜在切除范围外有转移性疾病。术前通过腹腔镜检查发现30例转移患者（敏感性77%），联合成像发现15例（敏感性38%）（p<0.01）。24例腺癌患者发生腹腔转移，术前腹腔镜检查发现23例（敏感性96%），联合成像发现5例（敏感性21%）（p<0.01）。鳞状细胞癌患者未见腹腔转移。15例患者有肝转移，术前腹腔镜检查发现9例（敏感性60%），联合成像发现7例（敏感性47%）。在检测腺癌患者转移方面，腹腔镜检查比联合成像更敏感[腹腔镜检查28例，联合成像10例（p<0.01）]。
在分期方案中增加腹腔镜检查避免了20例腺癌患者进行无益的胸腹探查。因此，在对食管胃区域腺癌患者进行切除手术前，应使用腹腔镜检查进行评估。
