Laparoscopy and lesser sac endoscopy in gastric carcinoma operability assessment

The results of 502 laparoscopy and 200 lesser sac endoscopy applications in 502 patients with gastric carcinoma for operability assessment are studied. Laparoscopy demonstrated a 94.74 per cent sensitivity for diagnosis of peritoneal disseminations and liver metastases. However, laparoscopy failed to establish inoperability in any cases of carcinoma spread to areas not accessible to laparoscopic visualization. Of these latter cases, 95.74 per cent were caused by tumor spread to the lesser sac retroperitoneum. Thus, the resultant sensitivity of laparoscopy in gastric carcinoma inoperability diagnosis was only 42.35 per cent. Lesser sac endoscopy made it feasible to inspect all of the organs and tissues forming the lesser sac. Of 200 patients assessed by lesser sac endoscopy, invasion of gastric posterior wall serosa was found in 89, retroperitoneal tumor invasion in 97, and retroperitoneal metastases in 42. The sensitivity of gastric carcinoma inoperability diagnosis by lesser sac endoscopy was 93.44 per cent and in combination with laparoscopy, 96.7 per cent. Utilization of lesser sac endoscopy in patients with gastric carcinoma minimized the number of exploratory laparotomies 6.4 times in comparison with only laparoscopy use and was responsible for diminishing this number to 5 per cent of the total number of examined patients.