胃癌术前即刻腹腔镜分期

Immediately preoperative laparoscopic staging for gastric cancer.

作者信息

D'Ugo D M, Coppola R, Persiani R, Ronconi P, Caracciolo F, Picciocchi A

机构信息

Department of General Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo Gemelli, 8, 00168-Rome, Italy.

出版信息

Surg Endosc. 1996 Oct;10(10):996-9. doi: 10.1007/s004649900222.

DOI:10.1007/s004649900222

PMID:8864093

Abstract

BACKGROUND

This ongoing study is a prospective evaluation of immediately preoperative video-laparoscopy compared to ultrasound/computed tomography (US/CT) staging for gastric cancer. An analysis of the first 70 cases is reported.

METHODS

TNM staging is used to compare the US/CT findings and the laparoscopic findings with the gold standard for pathologic findings in resected specimens.

RESULTS

In our series 47 out of 70 cases are locally advanced cancers (stages III and IV): In this subset the predictive value of laparoscopic staging is 86.4%. Laparoscopy shows an overall staging accuracy of 68.6%, compared to 32.8% for US/CT. The difference is statistically significant as regards the T factor (T3: 69.7% vs 12. 1%, p < 0.002; T4: 84.2% vs 42.1%, p < 0.05); as regards the M factor, laparoscopy appears the most specific method for detecting peritoneal seeding.

CONCLUSIONS

This procedure plays a crucial role in determining the resectability of the tumor, thus avoiding unnecessary laparotomies. A meticulous staging becomes mandatory when applying modem treatment options (e.g., neo-adjuvant chemotherapy) to locally advanced cancers; in this context the use of staging laparoscopy will have a relevant impact on future treatment.

摘要

背景

这项正在进行的研究是对胃癌术前即刻视频腹腔镜检查与超声/计算机断层扫描（US/CT）分期进行前瞻性评估。本文报告了对前70例病例的分析结果。

方法

采用TNM分期法，将US/CT检查结果和腹腔镜检查结果与切除标本病理检查结果这一金标准进行比较。

结果

在我们的研究系列中，70例病例中有47例为局部进展期癌症（III期和IV期）：在这一子集中，腹腔镜分期的预测价值为86.4%。腹腔镜检查显示总体分期准确率为68.6%，而US/CT为32.8%。在T因子方面差异具有统计学意义（T3：69.7%对12.1%，p<0.002；T4：84.2%对42.1%，p<0.05）；在M因子方面，腹腔镜检查似乎是检测腹膜种植最具特异性的方法。