Laparoscopic evaluation of the risk of locoregional recurrence after radical surgery for gastric cancer.
OBJECTIVE: we studied the diagnostic utility of laparoscopy in patients who underwent absolute radical surgery (R0) for gastric adenocarcinoma and who were at risk for locoregional recurrence. Risk was considered to exist in patients with T3-T4 stage tumors (IUAC TNM classification) that invaded the serosa or affect nearby organs. These patients are candidates for clinical trials involving multimodal therapies, especially with neoadjuvant or intraperitoneal chemotherapy. METHOD: ninety consecutive patients with gastric adenocarcinoma diagnosed by endoscopic biopsy were studied. The tumors were considered to be operable and potentially resectable depending on the preoperative evaluation of spread. The gold standard was the pathology report, based on the resected piece or specific biopsies. RESULTS: in T3-T4 tumors, laparoscopy had a sensitivity of 81% and a specificity of 100%, whereas for an 80% prevalence the positive predictive value was 100%, the negative predictive value was 56%, and diagnostic accuracy was 84%. CONCLUSIONS: in global terms, laparoscopy is very useful in detecting and confirming malignant invasion of the serosa or neighboring organs. In this sense it is similar to other diagnostic staging techniques such as endoscopic echography, with the added advantages of requiring less operator skill and being available in any center where such tumors are treated.