Laparoscopy and laparoscopic ultrasound in the staging of gastric cancer

As patients with gastric cancer are offered choices between surgical resection, investigational neoadjuvant chemotherapy, palliative chemotherapy, or symptomatic relief alone, the need for accurate preoperative staging becomes apparent. Laparoscopy has been suggested as an accurate staging modality in a variety of upper gastrointestinal malignancies. It allows for assessment of the stage of the primary tumor, identification of hepatic or regional nodal metastases, and the detection of small volume peritoneal disease unappreciated by other noninvasive staging modalities such as computerized tomography, magnetic resonance imaging or endoscopic ultrasound. This article reviews the current literature concerning laparoscopy and laparoscopic ultrasonography (LUS) in the staging of gastric cancer. The Memorial Hospital experience with 92 patients is described. In this group, metastatic disease unappreciated by conventional staging modalities was found in 31 cases. The preliminary experience with LUS suggests that its addition to standard laparoscopy increases the sensitivity and specificity of M1 screening as well as introducing T and N staging capabilities.