"THE EFFICACY OF VIDEO LAPARASCOPY FOR RESECTABILITY PREDICTION OF GASTRIC CANCER "

Abstract

Cancer of the stomach carries poor prognosis. Surgery is the best treatment for gastric cancer. Prediction of survival depends on the stage at the time of presentation. Fluoroscopy, sonography, and computerized tomography are used for advanced gastric cancers staging, but they are not accurate enough to grade advanced gastric cancers. Laparoscopic findings of lesions under direct vision, are magnified 15 times and have been used for gastric cancer staging and more specific prediction. To demonstrate the importance of laparascopy, we carried out this study on 84 confirmed cases of gastric cancer prior to laparatomy. Results of computerized tomography were compared with the findings of laparascopies, and laparotomy was the gold standard in this study. Abdominal CT of gastric lesions had recommended resectability in 84 cases. Resectability was believed possible by laparoscopy only in 65 patients (19 false positives). Sixty-five patients were considered to have true positive diagnosis of resectability and one false negative and two false positive cases had false laparoscopic finding, which were confirmed by laparatomy and all of them were resectable. Eleven patients were diagnosed as stage IV because distant metastases were found during laparoscopy. This study showed that there are 42% differences between CT and laparoscopic findings. In this study the sensitivity and specifity of CT for stage II are respectively 77.7% and 82% but sensitivity and specifity of laparoscopy for stage III are respectively 78% and 55% and sensitivity and specifity of laparoscopy for stage III gastric cancer are respectively 94.5% and 100%. Laparoscopic examination is a valuable tool for diagnosing metastases and should be used for the management of advanced gastric cancers. We observed that 22% of patient had no need to undergo surgical operation, if they had pre-operative laparoscopic examination. This study suggests that terminally ill patients, and in advanced gastric cancer where surgery may be ineffective, laparascopic examination may predict and avoid unnecessary surgical interventions.