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The Role of Pretherapeutic Laparoscopy in the Selection of Treatment for Patients With Gastric Carcinoma: A Proposal for a Laparoscopic Staging System

From the Gastroenterology Department (LFO-O, VA-C, RM-S), Surgery Division; Medical Oncology Department (DG-R), Internal Medicine Division; and General Director (JdlG-S); Instituto Nacional de Cancerología, México D.F. México.

Correspondence: Address correspondence and reprint requests to: Luis F. Oñate-Ocaña, MD, Departamento de Gastroenterología, Instituto Nacional de Cancerología, San Fernando 22, México D.F. 14000. México; Fax: 52-56-28-04-64; E-mail: lonate{at}prodigy.net.mx

Background: A pretherapeutic staging system to design nonoperative or neoadjuvant treatments in gastric cancer is required. In this study, a simple staging system based on laparoscopic findings to define a treatment algorithm was developed.

Methods: A retrospective cohort study was conducted of 151 patients allocated into four stages based on laparoscopic findings. The depth of tumor invasion and the presence of metastasis based on laparoscopic findings were used to construct these stages. Laparoscopic findings were compared with histopathology.

Results: An excellent agreement of the laparoscopy-defined depth of invasion and the surgical pathology standard was found (weighted kappa 0.85). The likelihood ratios for a positive and negative laparoscopic diagnosis of metastasis were 40.4 and 0.015, respectively (98.5% sensitivity, 97.6% specificity). Those for positive and negative diagnosis of resectability were 2.6 and 0.03, respectively (98.4% sensitivity, 62% specificity). The laparoscopic stages presented significant prognostic value. Two-year survival was 93%, 69%, 60%, and 17%, respectively. Surgical resection was possible in 100%, 100%, 49%, and 12%, respectively.

Conclusions: The proposed laparoscopic staging system is a simple and reproducible way for selection of a suitable therapy. It allows for adequate stratification of the main risk factors in the setting of clinical trials evaluating preoperative treatments.

Key Words: Gastric adenocarcinoma • Stomach cancer • Laparoscopy • Preoperative staging • Resectability • Neoadjuvant treatments

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