Abstract

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 neoadjuvant chemotherapy and prepare the operation far 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. Abdomi- nal CT staging, preoperative laparoscopic staging, and staging with CT and laparoscopy were compared for serosal infiltration, lymph node metastasis, peritoneal seeding and hepatic me- tastasis. 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 or false upon surgical and histo- logic 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, while liver metas- tasis 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).