[Laparoscopy in the staging of cancer of the stomach]

Prognosis of gastric carcinoma is closely related to extension. Laparoscopic staging of digestive cancers is proposed to evaluate the regional cancer spreading (TNM). The aim of this procedure is to avoid unnecessary laparotomy, and to reduce mortality and morbidity of these procedures. Laparoscopic staging can also make easier the selection of patients of preoperative treatment. In most of the series about laparoscopic staging, efficacy of the usual staging tools (computed tomography, ultrasonography, endoscopic ultrasonography) is weak and before operation 20 to 30% of the metastases, particularly peritoneal and hepatic, are missed. Laparoscopic staging is technically easy: no more than 3 trocars are necessary, laparoscopic ultrasonography may be performed during the same procedure, as well as peritoneal cytology. Feasibility is about 100%. Usual contraindications of the laparoscopy are contraindications of laparoscopic staging. The main difficulty is its utility. Staging of advanced lesions remains the best indication of laparoscopic staging in gastric cancer. Metastatic spread, particularly to the peritoneum, and resectability may be evaluated with sensitivity and specificity close to 90%. Morbidity (1 to 3%) is usually low and mainly represented by wound complications.