Publication:

Evaluation of role of staging laparoscopy as an adjunct to CECT abdomen staging in carcinoma stomach

Background Gastric cancer (CG) is the fifty most common cancer among males and seventh most common cancer among females in India. Prognosis in gastric cancer is very much related to pathological staging. Over the last decade management of gastric cancer has evolved from surgeon to multidisciplinary approach. Laparoscopy has been proposed as an accurate staging modality in a variety of upper gastrointestinal malignancies.

Methods The present cross-sectional prospective hospital-based study was conducted in the department of surgery, pt. J.N.M medical college Raipur, Chhattisgarh, India, during study period July 2016 to June 2018.  All the patients of endoscopic biopsy proven gastric cancer (50 cases) who presented during study period and satisfied the inclusion criteria underwent investigations like hemogram, renal function tests, liver function tests, CEA, CA 19-9, chest X-ray, CECT Abdomen and pelvis, staging laparoscopy. Standard protocols were followed for CECT abdomen scan, staging laparoscopy. Appropriate management of the cases were done.

Results In this study, most common symptom associated with carcinoma stomach was upper abdominal pain which was present in 42 cases (84%). Most common site for tumor was pylorus in 38 cases (76%). 2nd most common site for tumor was fundus in 8 cases (16%) followed by body in 3 cases (6%) and diffuse in 1 case (2%).  CECT staged 2 cases (4%) as stage I (IA-0, IB-2), 11 cases (22%) as stage II (IIA-3, IIB-8) and 37 cases (74%) as stage III (IIIA- 18, IIIB-05, IIIC-14). Surgery with curative intent was done in 15 cases (30%). In 32 cases (64%) due to disseminated disease as found on staging laparoscopy, surgery was abandoned and patients were sent for Neoadjuvant chemotherapy.

Conclusions Laparoscopy is a valuable technique in staging carcinoma stomach and has an important role in detection of occult extensive intra-abdominal or metastatic disease.