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11-06-2015 | Gastric cancer | Book chapter | Article

10. The Role of Staging Laparoscopy and Peritoneal Cytology in Gastric Cancer

Authors: MD James P. De Andrade, MD James J. Mezhir, MD Vivian E. Strong

Publisher: Springer International Publishing

Abstract

Staging laparoscopy is an important yet underutilized tool in the treatment of patients with gastric adenocarcinoma. The principle goal of staging laparoscopy is to identify patients with operable primary lesions absent of macroscopic or microscopic metastatic disease. Despite appropriate preoperative radiographic staging, approximately a quarter of the patients with seemingly operable disease are in fact found to have occult gross metastatic lesions on staging laparoscopy. Moreover, patients with advanced lesions (serosal invasion, nodal disease) are particularly at a high risk of microscopic metastases into the surrounding peritoneal fluid. Sampling the peritoneal fluid for free tumor cells during laparoscopy identifies patients with microscopic metastatic disease, a diagnosis that portends a similarly poor prognosis to patients with gross metastatic disease. Identifying these patients prior to laparotomy not only saves the patient the morbidity of a needless major surgery but also prevents the delay of further chemotherapy.

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