Discussion:
As in any malignancy, pre-operative staging of cancer stomach is a crucial step in assessing the prognosis and planning the treatment strategy. Recent diagnostic modalities e.g. CT scan and MRI do not have the sufficient accuracy. Depending on their results alone may expose the patient to unnecessary laparotomy (9). Assessment of tumor resectability by laparotomy was reported to have morbidity rate of 13-
23% and mortality rate of 10-21% in unresectable patients (10). Limitations of CT scan in proper staging of gastric cancer may include concurrent perforation,
T3 tumors in which extra-mural tumor may not be differentiated from early local peritoneal involvement, and the time lapse between CT scan and surgery specially in patients …show more content…
In 8 patients included in the current study
(22.8%), the diagnostic laparoscopy showed liver nodules, peritoneal nodules, and ascetic fluid.
Metastatic nature was confirmed in 7 out of these 8 patients with a sensitivity rate of 100%. So, diagnostic laparoscopy saved 7 patients (20%) unnecessary laparotomy with no morbidity or mortality.
These results are consistent with results from other studies. Gretschel et al reported in their study a sensitivity rate of 85% for detection of peritoneal metastases by diagnostic laparoscopy (14). In another study by Karanicolas et al (13), they reported that in
30% of patients futile laparotomy can be avoided by diagnostic laparoscopy.
The metastatic disease was diagnosed in 17% of cases by diagnostic laparoscopy in another study by
Mahadevan et al (9).
However, diagnostic laparoscopy is not without limitations. T1 and T2 patients are difficult to be assessed by laparoscopy. Also, the lymph node status assessment did not show significant difference when we compare laparoscopy with CT scan (15).
In conclusion, the use of diagnostic laparoscopy in patients with gastric cancer is a simple
As in any malignancy, pre-operative staging of cancer stomach is a crucial step in assessing the prognosis and planning the treatment strategy. Recent diagnostic modalities e.g. CT scan and MRI do not have the sufficient accuracy. Depending on their results alone may expose the patient to unnecessary laparotomy (9). Assessment of tumor resectability by laparotomy was reported to have morbidity rate of 13-
23% and mortality rate of 10-21% in unresectable patients (10). Limitations of CT scan in proper staging of gastric cancer may include concurrent perforation,
T3 tumors in which extra-mural tumor may not be differentiated from early local peritoneal involvement, and the time lapse between CT scan and surgery specially in patients …show more content…
In 8 patients included in the current study
(22.8%), the diagnostic laparoscopy showed liver nodules, peritoneal nodules, and ascetic fluid.
Metastatic nature was confirmed in 7 out of these 8 patients with a sensitivity rate of 100%. So, diagnostic laparoscopy saved 7 patients (20%) unnecessary laparotomy with no morbidity or mortality.
These results are consistent with results from other studies. Gretschel et al reported in their study a sensitivity rate of 85% for detection of peritoneal metastases by diagnostic laparoscopy (14). In another study by Karanicolas et al (13), they reported that in
30% of patients futile laparotomy can be avoided by diagnostic laparoscopy.
The metastatic disease was diagnosed in 17% of cases by diagnostic laparoscopy in another study by
Mahadevan et al (9).
However, diagnostic laparoscopy is not without limitations. T1 and T2 patients are difficult to be assessed by laparoscopy. Also, the lymph node status assessment did not show significant difference when we compare laparoscopy with CT scan (15).
In conclusion, the use of diagnostic laparoscopy in patients with gastric cancer is a simple