Article
Surgical and multimodality therapy of gastric cancer with peritoneal carcinosis
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Published: | March 20, 2006 |
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Gastric cancer frequently spreads to the peritoneal cavity. The general value of laparoscopy for planning therapy remains controversial. We investigated its utility compared to other diagnostic tools. We included 660 consecutive gastric cancer patients treated between 1992-2004. We compared abdominal ultrasound (US), computed tomography (CT), and staging laparoscopy (SLAP) in terms of sensitivity for detecting synchronous peritoneal carcinomatosis (PCA). The lesions were biopsied and classified as P1, P2, or P3 according to Japanese Research Society for Gastric Cancer. The patients were followed and their prognosis was determined according to the PCA stage and various therapeutic procedures. 110 of 660 patients (17%) presented with synchronous PCA. Thirty-seven PCA patients (34%) were classified as P1, 22 (20%) as P2, and 51 (46%) as P3. The sensitivity for detecting PCA by SLAP was 85% compared to 19% for US; and 28% for CT. False negative SLAP results were caused by adhesions from prior surgery or small non-visible PCA-implants. P3 patients did not benefit from additional surgery, compared to chemotherapy alone. P1 patients showed improved survival rates after complete resection followed by chemotherapy. SLAP improves PCA detection and classification and offers gastric cancer patients a more individualised and effective therapy.