Laparoscopy and laparoscopic ultrasonography in staging of carcinoma of the esophagus and gastric cardia

• Published in: Journal of the American College of Surgeons Vol. 181; no. 5; pp. 421 - 425
• Main Authors: BEMELMAN, W. A, VAN DELDEN, O. M, VAN LANSCHOT, J. J. B, DE WIT, L. T, SMITS, N. J, FOCKENS, P, FOUMA, D. J, OBERTOP, H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01-11-1995
• Subjects: Biological and medical sciences; Cardia; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Laparoscopy; Male; Medical sciences; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Preoperative Care; Prospective Studies; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Ultrasonography; Sonography; Human; Carcinoma; Staging; Esophageal disease; Cardia; Laparoscopy; Malignant tumor; Esophagus; Echography; Digestive diseases; Endoscopy; Preoperative; Gastric disease
• ISSN: 1072-7515; 1879-1190

The objective of this prospective study was to assess the contribution of laparoscopy combined with laparoscopic ultrasonography (LLU) in the preoperative staging of patients with carcinoma of the esophagus and cardia.
Preoperative LLU was performed in 56 patients who were selected for curative resection of carcinoma of the esophagus (n = 38) or gastric cardia with involvement of the distal esophagus (n = 18) after routine preoperative workup. During LLU, the peritoneal cavity was scrutinized for metastatic disease, and ultrasonography of the liver and celiac axis was performed. In all patients without histologically proven metastases, laparotomy was then performed.
The morbidity rate of the procedure was 3.5 percent (two superficial wound infections). In three (5 percent) of the 56 patients, laparotomy was excluded by the presence of intra-abdominal metastases. In three other patients, laparotomy was necessary to confirm the suspected hepatic or peritoneal metastases, or both, because histologic proof was not obtained at laparoscopy. In one patient, LLU failed to detect a small hepatic metastasis in segment VII. The preoperative stage was altered by laparoscopy in nine (17 percent) patients (M1 in six, T4 in three). Laparotomy was avoided in two (11 percent) and the preoperative stage changed in seven patients (41 percent), all of whom had carcinoma of the gastric cardia, as occurred in one (3 percent) and two (6 percent) patients with middle and distal carcinoma of the esophagus, respectively.
Preoperative staging by LLU is of little value in patients with carcinoma of the middle and lower esophagus. The probable role of LLU in the staging of patients with carcinomas of the gastric cardia remains to be confirmed in larger series.