Laparoscopy in the management of gastric adenocarcinoma
Laparoscopy in the management of gastric adenocarcinoma
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DOI：
10.1097/00000658-199703000-00004
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发表时间：
1997-03-01
影响因子：
9
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Burke, EC;Karpeh, MS;Brennan, MF
目的 作者确定了腹腔镜检查在检测胃腺癌患者转移性疾病方面的准确性。背景数据摘要 在美国，大多数胃腺癌患者均处于晚期疾病。方法 1991年12月至1995年12月在Memorial-Sloan Kettering癌症中心接受腹腔镜检查的111例胃腺癌患者。术前CT扫描均判断无腹腔内转移。结果 111例患者中，110例腹腔镜探查成功。 对 94% 的患者进行了转移性疾病的准确分期，敏感性为 84%，特异性为 100%。转移性疾病的患病率为37%。 24 名患者仅接受腹腔镜检查，平均出院时间为 1.4 天，而接受剖腹探查术但未进行切除术的患者平均出院时间为 6.5 天（p < 0.05）。没有仅接受腹腔镜检查的患者返回接受姑息性手术。结论 在美国，腹腔镜检查应在无梗阻、无出血的进展期胃癌患者中进行。这些患者中有超过三分之一在手术时患有未预料到的转移性疾病。腹腔镜检查在检测隐匿性转移方面高度准确，并可识别独特的 IV 期患者群体，这些患者可能受益于更新的诱导化疗方法，同时避免不必要的剖腹手术。
Objective The authors determined the accuracy of laparoscopy in detecting metastatic disease in patients with gastric adenocarcinoma.Summary Background Data The majority of patients with gastric adenocarcinoma in the United States present with advanced disease. They are at high risk for intraabdominal metastatic spread.Methods One hundred eleven patients with gastric adenocarcinoma underwent laparoscopy at Memorial-Sloan Kettering Cancer Center from December 1991 to December 1995. All were judged to be free of intra-abdominal metastatic disease on preoperative computed tomographic scan imaging.Results Laparoscopic exploration was successful in 110 of 111 patients and accurately staged 94% of the patients with respect to metastatic disease with a sensitivity of 84% and a specificity of 100%. The prevalence rate of metastatic disease was 37%. Twenty-four patients underwent laparoscopy only and were discharged in an average 1.4 days versus 6.5 days in patients undergoing exploratory laparotomy without resection (p < 0.05). No patients undergoing laparoscopy only have returned for palliative surgery.Conclusions Laparoscopy should be performed in nonobstructed, nonbleeding patients with advanced gastric cancer in the United Stales. More than one third of these patients have unsuspected metastatic disease at time of operation. Laparoscopy is highly accurate in detecting occult metastases and identifies a unique population of stage IV patients who may benefit from newer induction chemotherapeutic approaches while avoiding unnecessary laparotomy.