The Role of Laparoscopy in the Staging of Gastric Cancer

Abstract

The earliest recorded use of laparoscopy in patients with carcinoma of the stomach is from 1971 [1], when it was used to provide a minimally invasive means of diagnosing intra-abdominal metastatic disease. Since this report a further 15 series describing its use in gastric and distal esophageal carcinoma [2–16] have been published. The use of this technique to define metastatic disease was encouraged by the observation that gastric resection in patients with metastatic disease was associated with a complication rate of 23% and a perioperative mortality rate of up to 25% [18–20]. In addition, a feature of the biology of gastric carcinoma is transperitoneal spread characteristically leaving multiple small peritoneal implants that are often not detected preoperatively. The introduction of laparoscopy expressed the recognition that the available modalities for preoperatively staging gastric cancer, namely clinical examination, plain abdominal X-ray, liver function tests, transabdominal ultrasound (US), and computed tomographic (CT) scanning were limited in their ability to define both peritoneal and hepatic metastatic disease [5] and that the performance of palliative gastric resections leaving behind residual peritoneal or hepatic metastases did not improve survival over that observed in unresected patients [19, 20].