Role of staging laparoscopy in gastric malignancies - our institutional experience

Table 1 Staging results of computed tomography scan and laparoscopy for upstaged-downstaged patients

	Computed tomography scan	Laparoscopy	Peritoneal cytology
Upstaging
1	CEJ thickening	Peritoneal nodules	Positive
2	Irregular thickening of anterior stomach wall? Left lobe liver invasion	Omental nodules; no liver invasion	Not done
3	Diffuse thickening with perigastric nodes	Peritoneal and omental nodules	Atypical cells
4	Diffuse thickening with perigastric nodes	Peritoneal nodules	Positive
5	Thickening of gastric wall	Peritoneal nodules; invasion to left lobe of liver	Positive
6	CEJ tumour with diffuse abdominal lymphadenopathy	Omental nodules	Atypical cells
7	Irregular thickening of gastric wall with enlarged splenic hilar, porta hepatic, peripancreatic and para-aortic nodes	Moderate ascites; secondary deposits in pylorus	Atypical cells? Suspicious for malignancy
8	Grossly distended stomach with circumferential enhancing tumour with multiple abdominal nodes and? liver lesion	Omental nodules	Atypical cells
9	Diffuse thickening of gastric mucosa and abdominal lymphadenopathy with? liver hypodensity	Ascites; peritoneal nodules	Positive
10	CEJ malignancy with lesser curvature lymphadenopathy with? Invasion into the pancreas	Peritoneal nodules	Positive
11	CEJ tumour with perigastric lymph nodes	Serosal involvement	Negative
12	Diffuse gastric wall thickening with abdominal lymphadenopathy	Bulky tumour invading serosa and left lobe of liver	Atypical cells, favour reactive
13	Diffuse gastric wall thickening with abdominal lymphadenopathy	Omental nodules	Positive
Down staging
1	Regional lymphadenopathy with liver metastases	Mobile tumour at antrum with no liver metastases on laparoscopic ultrasound	Negative

CEJ: Carcio-esophageal junction.

Table 2 Advantages and disadvantages of staging laparoscopy for digestive cancers

Advantages	Disadvantages
Less invasive procedure compared to open laparotomy	It is an invasive procedure with risk of general anesthesia
Can avoid unnecessary laparotomy and indirect cost savings	Possible delay in definitive treatment
Additional palliative procedures can be performed	Added resource utilization and cost