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Machairas N, Charalampoudis P, Molmenti EP, Kykalos S, Tsaparas P, Stamopoulos P, Sotiropoulos GC. The value of staging laparoscopy in gastric cancer. Ann Gastroenterol 2017; 30:287-294. [PMID: 28469358 PMCID: PMC5411378 DOI: 10.20524/aog.2017.0133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/19/2017] [Indexed: 12/26/2022] Open
Abstract
Treatment options for patients with gastric cancer (GC) are based on tumor staging and resectability. Although only surgery provides improved survival, resection is contraindicated and should be avoided in the presence of intra-abdominal disease stage M1 (liver, peritoneal, or non-local lymph node metastases). Thus, a detailed and precise evaluation is imperative for optimal treatment. Staging laparoscopy (SL) constitutes a major tool in the accurate diagnosis of several types of cancers, including GC. SL presents several critical advantages: it can diagnose intra-abdominal disease; serve as a complement to other imaging studies; allow for biopsies; facilitate intraoperative ultrasound evaluations; allow for sampling of peritoneal fluid for cytological examination; and serve as an option for the administration of intraperitoneal chemotherapy. Although considered and advocated as a very useful asset in the pre-treatment cancer-staging arsenal, the wider application of SL has been long debated. The purpose of our study was to evaluate the contribution of laparoscopy to GC staging.
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Affiliation(s)
- Nikolaos Machairas
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece (Nikolaos Machairas, Petros Charalampoudis, Stylianos Kykalos, Peter Tsaparas, Paraskevas Stamopoulos, Georgios C. Sotiropoulos)
| | - Petros Charalampoudis
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece (Nikolaos Machairas, Petros Charalampoudis, Stylianos Kykalos, Peter Tsaparas, Paraskevas Stamopoulos, Georgios C. Sotiropoulos)
| | - Ernesto P Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York, USA (Ernesto P. Molmenti)
| | - Stylianos Kykalos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece (Nikolaos Machairas, Petros Charalampoudis, Stylianos Kykalos, Peter Tsaparas, Paraskevas Stamopoulos, Georgios C. Sotiropoulos)
| | - Peter Tsaparas
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece (Nikolaos Machairas, Petros Charalampoudis, Stylianos Kykalos, Peter Tsaparas, Paraskevas Stamopoulos, Georgios C. Sotiropoulos)
| | - Paraskevas Stamopoulos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece (Nikolaos Machairas, Petros Charalampoudis, Stylianos Kykalos, Peter Tsaparas, Paraskevas Stamopoulos, Georgios C. Sotiropoulos)
| | - Georgios C Sotiropoulos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece (Nikolaos Machairas, Petros Charalampoudis, Stylianos Kykalos, Peter Tsaparas, Paraskevas Stamopoulos, Georgios C. Sotiropoulos)
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Yang H, Wang J, Huang Q, Zheng Y, Ela Bella A, Wang R, Fu J, Li A, Li X. Intraoperative ultrasonography for the identification of thoracic recurrent laryngeal nerve lymph nodes in patients with esophageal cancer. Dis Esophagus 2015; 29:152-8. [PMID: 25604726 DOI: 10.1111/dote.12318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The rate of vocal cord palsy following resection for esophageal carcinoma has increased due to lymphadenectomy around the recurrent laryngeal nerves (RLN). The aim of this pilot study was to assess the ability of intraoperative ultrasonography to detect thoracic RLN node metastases in patients with esophageal cancer. Intraoperative ultrasonography was performed during esophagectomy to assess whether RLN lymph nodes were metastatic in 10 patients with esophageal squamous cell cancer. All patients underwent RLN lymphadenectomy, and the nodes were assessed for metastasis. Three patients had pathological RLN lymph node metastases, of which one had right RLN node metastasis, and three had left RLN node metastases. For detecting right RLN lymph node metastasis, the sensitivity, specificity, and positive and negative predictive values of intraoperative ultrasonography were 100%, 33.3%, 14.3%, and 100%, respectively. For the detection of left RLN lymph node, these values were 100%, 85.7%, 75%, and 100%, respectively. This study suggests that intraoperative ultrasonography is feasible and safe to detect RLN lymph node metastases for patients with esophageal cancer. Further study will be performed to evaluate the validity and utility of this diagnostic technique.
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Affiliation(s)
- H Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - J Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Q Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Y Zheng
- Department of Surgical Oncology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - A Ela Bella
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - R Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - J Fu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - A Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - X Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Esophageal Cancer Institute, Guangzhou, China
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Abstract
Gastric cancer is common worldwide. Tumor location and disease stage differ between Asian and Western countries. Western patients often have higher BMIs and comorbidities that may make laparoscopic resections challenging. Multiple trials from Asian countries demonstrate the benefits of laparoscopic gastrectomy for early gastric cancer while maintaining equivalent short-term and long-term oncologic outcomes compared with open surgery. The outcomes of laparoscopy seem to offer equivalent results to open surgery. In the United States, laparoscopic gastrectomy remains in its infancy and is somewhat controversial. This article summarizes the literature on the epidemiology, operative considerations and approaches, and outcomes for laparoscopic gastrectomy.
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Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Feinberg School of Medicine, Northwestern University, East Huron Street, Galter 3-150, Chicago, IL 60611, USA
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Shelat VG, Thong JF, Seah M, Lim KH. Role of staging laparoscopy in gastric malignancies - our institutional experience. World J Gastrointest Surg 2012; 4:214-9. [PMID: 23293736 PMCID: PMC3536860 DOI: 10.4240/wjgs.v4.i9.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/17/2012] [Accepted: 09/17/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of staging laparoscopy with laparoscopic ultrasound (LUS) and peritoneal lavage cytology in patients with newly-diagnosed gastric tumours in our department.
METHODS: Retrospective review of prospectively-collected data was conducted in all patients with newly-diagnosed gastric tumours on oesophagogastroduodenoscopy between December 2003 and July 2008. All the patients had a pre-treatment histological diagnosis and were discussed at the hospital multidisciplinary tumour board meeting for their definitive management. Computed tomography scan was performed in all patients as a part of standard preoperative staging work up. Staging laparoscopy was subsequently performed in selected patients and staging by both modalities was compared.
RESULTS: Twenty seven patients were included. Majority of patients had cardio-oesophageal junction adenocarcinoma. Thirteen patients (48%) were upstaged following staging laparoscopy and one patient was downstaged (3.7%). None of the patients had procedure-related complications. None of the patients with metastasis detected at laparoscopy underwent laparotomy. Gastrectomy after staging laparoscopy was performed in 13 patients (9 R0 resections, 3 R1 resections and 1 R2 resection). Only one patient did not have gastrectomy at laparotomy because of extensive local invasion. Three patients were subjected to neoadjuvant therapy following laparoscopy but only one patient subsequently underwent gastrectomy.
CONCLUSION: In this small series reflecting our institutional experience, staging laparoscopy appears to be safe and more accurate in detecting peritoneal and omental metastases as compared to conventional imaging. Peritoneal cytology provided additional prognostic information although there appeared to be a high false negative rate.
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Affiliation(s)
- Vishal G Shelat
- Vishal G Shelat, Juin Fong Thong, Melanie Seah, Khong Hee Lim, Department of Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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