Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

Background: It is estimated that 990000 new gastric cancer (GC) cases occur in the world annually. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination and to determine the influence of staging laparoscopy on treatment decisions in gastric cancers.Methods: This was a prospective study conducted in a tertiary care hospital between August 2014 and February 2016. Thirty patients out of a series of 60 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted.Results: The strengths of agreement between the CT stage and the final histopathological stage were Kw- 0.314 (95% confidence interval [CI]; 0.03-0.66; P≥0.0001) for T stage and 0.00 (95% CI; 0.0-0.00) for M stage, compared with 0.668 (95% CI; 0.39-0.98; P≥0.0001) and 1.00 (95% CI; 1.0-1.0; P≥0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 12 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT.Conclusions: Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT and influences treatment decision making apart from preventing unnecessary laparotomies

Role of staging laparoscopy to evaluate feasibility of performing optimal cytoreductive surgery in epithelial ovarian cancers

Background: The main stay of treatment for epithelial ovarian cancers is surgical cytoreduction. CT scan and staging laparotomy are methods used to assess feasibility to carry out optimal cytoreduction. We evaluated the role of staging laparoscopy in assessing operability for optimal cytoreduction as well as avoidance of unnecessary laparotomies.Methods: Between September 2014-2016, 23 patients of epithelial ovarian cancer underwent staging laparoscopy as part of evaluation method to check feasibility to carry out optimal cytoreductive surgery. The findings were correlated with clinical findings as well as CT scan findings. The impact of laparoscopy to predict operability was studied as well as its use to avoid unnecessary laparotomies.Results: Laparoscopy could correctly evaluate the nature of abdominal mass in 91.3% patients. It picked up omental and peritoneal deposits in 87% and 95.7% patients respectively as compared to 60.9% and 39% picked up on CT scan. More importantly laparoscopy could diagnose mesenteric and small bowel deposits in 34.8% of patients which were never reported on CT scan. The overall impact was reduction in unnecessary laparotomies.Conclusions: Laparoscopic evaluation is a useful adjunct prior to performing a formal laparotomy in epithelial ovarian cancer cytoreductive surgery

Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

Background: It is estimated that 990000 new gastric cancer (GC) cases occur in the world annually. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination and to determine the influence of staging laparoscopy on treatment decisions in gastric cancers.Methods: This was a prospective study conducted in a tertiary care hospital between August 2014 and February 2016. Thirty patients out of a series of 60 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted.Results: The strengths of agreement between the CT stage and the final histopathological stage were Kw- 0.314 (95% confidence interval [CI]; 0.03-0.66; P≥0.0001) for T stage and 0.00 (95% CI; 0.0-0.00) for M stage, compared with 0.668 (95% CI; 0.39-0.98; P≥0.0001) and 1.00 (95% CI; 1.0-1.0; P≥0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 12 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT.Conclusions: Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT and influences treatment decision making apart from preventing unnecessary laparotomies

Role of staging laparoscopy to evaluate feasibility of performing optimal cytoreductive surgery in epithelial ovarian cancers

Background: The main stay of treatment for epithelial ovarian cancers is surgical cytoreduction. CT scan and staging laparotomy are methods used to assess feasibility to carry out optimal cytoreduction. We evaluated the role of staging laparoscopy in assessing operability for optimal cytoreduction as well as avoidance of unnecessary laparotomies.Methods: Between September 2014-2016, 23 patients of epithelial ovarian cancer underwent staging laparoscopy as part of evaluation method to check feasibility to carry out optimal cytoreductive surgery. The findings were correlated with clinical findings as well as CT scan findings. The impact of laparoscopy to predict operability was studied as well as its use to avoid unnecessary laparotomies.Results: Laparoscopy could correctly evaluate the nature of abdominal mass in 91.3% patients. It picked up omental and peritoneal deposits in 87% and 95.7% patients respectively as compared to 60.9% and 39% picked up on CT scan. More importantly laparoscopy could diagnose mesenteric and small bowel deposits in 34.8% of patients which were never reported on CT scan. The overall impact was reduction in unnecessary laparotomies.Conclusions: Laparoscopic evaluation is a useful adjunct prior to performing a formal laparotomy in epithelial ovarian cancer cytoreductive surgery