Lesser sac endoscopy in gastric carcinoma: operability assessment

Since 1983, endoscopic evaluation of the lesser sac has been used in assessing operability in patients with gastric carcinoma. In this prospective study, the results of lesser sac endoscopy application in 200 patients divided into two groups are analyzed. Serosal layer invasion of the posterior gastric wall was found in 89 patients. Direct retroperitoneal invasion and metastases were found in 97 and 42 patients, respectively, and confirmed histopathologically in 24. The reproducibility of the applied method was 96.15 and 99%, the sensitivity of the diagnosis of inoperability was 88.23 and 93.44%, and the sensitivity of the diagnosis of tumor spread was 98 and 98.5%, respectively, in patients of Groups 1 and 2. The use of lesser sac endoscopy, permitting accurate assessment for metastases and visceral and retroperitoneal invasion, was found to allow better staging than laparoscopy alone and thereby reduced by 5.8 times the number of exploratory laparotomies performed in patients with gastric carcinoma.