The purpose of this study is to evaluate the usefulness of preoperative laparoscopic examination in gastric cancer. A more accurate preoperative cancer staging may allow a better prepared setting in which to avdoid unnecessary laparotomy, decide
preoperative neoadjuvantchemotherapy and prepare the operation for combined resections or intraoperative radiotherapy. The subjects of this study were the 105 patients who were diagnosed preoperatively by gastrofiberscopic examination with biopsy
and
had received gastric resections in our department from 1986 to 1993. We performed laparoscopy preoperatively in all patients to characterize the location of the tumor and its and regional infiltration. Abdominal CT staging, preoperative
laparoscopic
staging, and staging with CT and laparoscopy were compared for serosal infiltration, lymph node metastasis, peritoneal seeding and hopatic metastasis. The diagnostic indices such as sensitivity, specificity, accuracy, prevalence and predictive
value of
each staging were calculated and compared For the statistical interpretation of the results, diagnostic indexes were calculated in two-way contingency tables of the frequencies of positive and negative results construed as either true of false
upon
surgical and histologic evaluation. The sensitivities for laparoscopic examination of serosal invasion, lymph node-metastasis, peritoneal seeding and liver metastasis were 87.3%, 26.8%, 37.5% and 10.5% respectivelym and the specificity of the
above
findings were 61.8%, 76.5%, 100% and 94.2% respectively. The sensitivities of CT staging for above findings were 50.7%, 39.4%, 0%, 15.8% respectively, and the specificity was 73.5% 97.1%, 99.0%, 93.0% respectively. The sensitivity of combined
modalities
for above findings were 94.4%, 59.2%, 50.0%, 15.8% respectively, and the specificity was 70.6%, 70.6%, 99%, 94.2% respectively, and which indicates that seosal invasion, lymph node metastasis and peritoneal seeding could be detected accurately,
which
liver metastasis could not be.
1) Serosal infiltration was more accurately diagnosed by preoperative laparoscopy (sensitivity 87.3%, specificity 61.8%, p=0.024).
2) Diagnostic indices of lymph node metastasis, peritoneal seeding and liver metastasis were not different between preoperative laparoscopy and CT(p>0.05).
3) Preoperative combined examination f laparoscopy and CT was superior diagnostic method when compared to each modality alone for detection of spread to serosa and peritoneal metastasis.
4) CT scanning was more efficient diagnostic tool for the regional lymph node and hepatic metastasis of gastric cancer.
From the current results, we find that preoperative evaluation with the addition of laparoscopic examination is superior to CT imaging alone in accurately assessing the stage of serosal invasion and peritoneal seeding, allowing the surgeon to
chose
a
more effective treatment modality.
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