Laparoscopy, Computerised Tomogrpahy and Fluorodeoxyglucose Positron Emission Tomogrpahy Role in the Management of Gastric and Gastroesophageal Cancer

Ahmad Mirza, MD, Ian Welch, Simon Galloway. The University Hospital of South Manchester, Manchester, United Kingdon

INTRODUCTION: The staging laparoscopy has been used in management of gastrointestinal cancers. The aim of this study was to evaluate the role of staging laparoscopy, in comparison with computed tomography (CT) and Fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in staging patients with gastroesophageal junction (GOJ) and gastric cancer.

METHODS: The data were collected for patients between 1996 and 2013 for patients undergoing investigation and treatment for GOJ and gastric cancer at a single institute. The pre-operative data (staging data), intra-operative details, post-operative course and outpatient follow-up were analysed for individual cases.

RESULTS: Staging laparoscopy altered management plan in 54 (14%) of 387 patients. Patients with negative staging CT scan and negative FDG-PET, 7% (Type I, II and III GOJ) were identified with pathological intra-peritoneal nodes, metastatic intraperitoneal deposits (4%) and ascitic fluid (ascitic tap positive for cancer cells, 3%). Patients with metastatic disease were referred for palliative chemotherapy. The sensitivity of staging laparoscopy in diagnosing intrabdominal pathology was 86% in comparison to CT(81%) and FDG PET(78%).

CONCLUSIONS: Diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease not evident on the staging CT scan and FDG-PET, that potentially could alter treatment and prognosis in patients with upper gastrointestinal cancer. Diagnostic laparoscopy should be performed as part of investigation and treatment planning for patients suffering from GOJ cancers. This can potentially avoid surgery in patients with advanced disease and these patients can be started earlier on palliative chemotherapy.

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