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KMID : 0371320130840020080
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Journal of the Korean Surgical Society
2013 Volume.84 No. 2 p.80 ~ p.87
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Effectiveness of endoscopic clipping and computed tomography gastroscopy for the preoperative localization of gastric cancer
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Jeong Sang-Ho
Bae Kyung-Soo
Ha Chang-Youn
Lee Young-Joon
Lee Ok-Jae
Jung Woon-Tae
Choi Sang-Kyung
Hong Soon-Chan
Jung Eun-Jung
Ju Young-Tae
Jeong Chi-Young
Ha Woo-Song
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Abstract
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Purpose : Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap). Methods : In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis). Results : PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both). Conclusion : Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy.
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KEYWORD
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Stomach neoplasms, Laparoscopy, Gastrectomy, X-ray computed tomography, Gastroscopy
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