Usefulness of diagnostic laparoscopy with 5-aminolevulinic acid (ALA)-mediated photodynamic diagnosis for the detection of peritoneal micrometastasis in advanced gastric cancer after chemotherapy
Usefulness of diagnostic laparoscopy with 5-aminolevulinic acid (ALA)-mediated photodynamic diagnosis for the detection of peritoneal micrometastasis in advanced gastric cancer after chemotherapy
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DOI：
10.1007/s00595-016-1328-2
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发表时间：
2016-12-01
期刊：
影响因子：
2.5
通讯作者：
Sakon, Masato
中科院分区：
文献类型：
--
作者：
Kishi, Kentaro;Fujiwara, Yoshiyuki;Sakon, Masato
成功案例表明，化疗后进行转化手术可改善晚期胃癌的预后。但术前需谨慎选择无不可切除因素的患者。我们最近报道，使用口服 5-氨基乙酰丙酸 (ALA-PDD) 进行光动力诊断的诊断性腹腔镜检查是诊断胃癌早期腹膜转移的一种有前途的工具。我们在此评估了该技术用于检测化疗后晚期胃癌腹膜转移的有用性。对 38 例化疗后晚期胃癌患者进行了使用连续白光 (WL) 和 ALA-PDD 观察的诊断性腹腔镜检查。将 ALA-PDD 检测腹膜疾病的敏感性与 WL 进行比较。评估ALA-PDD评估的腹膜转移状态与腹腔液细胞学检查之间的关系。38例患者中，12例（32%）通过常规腹腔镜检查诊断为腹膜转移。然而，使用 ALA-PDD 的腹腔镜检查在其余 26 名患者中检测到 4 名（11%）存在腹膜转移。这 4 名患者中的 3 名腹腔液评估的细胞学结果为阴性。使用 ALA-PDD 进行诊断性腹腔镜检查是一种有用的技术，可用于检测转移并确定治疗策略，以选择接受化疗的晚期胃癌患者。
Successful cases have shown that conversion surgery after chemotherapy improves the prognosis of advanced gastric cancer. However, it is necessary to carefully select patients who have no unresectable factors prior to surgery. We recently reported that diagnostic laparoscopy with photodynamic diagnosis using oral 5-aminolevulinic acid (ALA-PDD) is a promising tool for diagnosing early peritoneal metastasis in gastric cancer. We herein evaluated the usefulness of this technique for detecting peritoneal metastases of advanced gastric cancer after chemotherapy.Diagnostic laparoscopy using sequential white light (WL) and ALA-PDD observations was performed in 38 patients with advanced gastric cancer after chemotherapy. The sensitivity of ALA-PDD for detecting peritoneal disease was compared with that of WL. The relationship between the state of peritoneal metastasis assessed by ALA-PDD and a cytological examination of the peritoneal fluid was evaluated.Twelve of the 38 patients (32 %) were diagnosed with peritoneal metastases by conventional laparoscopy. However, laparoscopy with ALA-PDD detected peritoneal metastases in 4 (11 %) of the 26 remaining patients. Three of these 4 patients had negative cytological results from the evaluation of the peritoneal fluid.Diagnostic laparoscopy using ALA-PDD is a useful technique for detecting metastases and determining treatment strategies to select patients with advanced gastric cancer who have received chemotherapy.