Assessment of gastric cancer by laparoscopy

Abstract

We studied 46 consecutive patients (33 men, 13 women) with histologically proved adenocarcinoma of the stomach. In two a mass suggested inoperable cancer and the examination was used to obtain objective proof. Laparoscopy was carried out under general anaesthesia. Both forward and side viewing techniques were used to obtain an optimum view of the peritoneal cavity. Biopsy specimens of metastases of the liver or peritoneum were taken under direct vision with a needle or biopsy forceps through a second puncture site. A tumour was deemed incurable if there were liver metastases or visible transperitoneal spread. No attempt was made to enter the lesser sac with the laparoscope as the degree of posterior fixity of a tumour is difficult to assess. There were no deaths, and morbidity was minimal. A few patients developed subcutaneous emphysema. In one case the Verres needle penetrated the transverse colon. This was recognized immediately and was repaired without further complications. No metastases were found in 19 patients, of whom 18 subsequently underwent laparotomy and one declined. Gastrectomy was undertaken in 16, but in two major posterior extension of the cancer prevented resection, and we performed palliative gastrojejunostomy. Of the 27 patients with incurable disease, most had extensive lesions precluding palliative distal gastrectomy and were treated symptomatically. Seven were referred to a medical oncologist and given cytotoxic chemotherapy as part of a trial of new chemotherapeutic agents. Six underwent endo-oesophageal intubation using an endoscopic technique. Two patients subsequently developed gastric outlet obstruction and required palliative gastroenterostomy. We conclude that laparoscopy is a useful method for the assessment of gastric cancer and allows easy biopsy, particularly of peritoneal deposits. Unnecessary laparotomy is avoided and the morbidity of the procedure is minimal.