Role of Staging Laparoscopy in Carcinoma Stomach

BACKGROUND: Diagnostic laparoscopy has been advocated as a way of improving staging in carcinoma stomach by detecting low volume liver surface and peritoneal metastasis which are usually missed by conventional imaging, thereby protecting the patient from an unnecessary laparotomy. AIMS AND OBJECTIVES: The present study was undertaken to ascertain the feasibility of using diagnostic laparoscopy as a routine staging investigation in patients with carcinoma stomach and to evaluate its superiority over conventional imaging modalities in detecting peritoneal and liver surface metastasis and to assess the morbidity and mortality associated with or without its use. MATERIALS AND METHODS: The study is a non-randomised controlled trial wherein 40 patients with carcinoma stomach proven by OGD and biopsy with no evidence of metastasis on CECT abdomen and pelvis were allocated into two groups. One group of 20 patients had a diagnostic laparoscopy done just before the definitive procedure while the other group did not. RESULTS AND DISCUSSION: Of the 20 patients in the diagnostic laparoscopy group, peritoneal metastasis were detected in 20% (4 out of 20), hence resulting in upstaging of disease and a change in treatment plan in all of them and also avoidance of unnecessary laparotomy in 10% (2 out of 20) cases. Moreover, the postoperative complications in the D-lap group without metastasis including wound infection, wound dehiscence, anastomotic leak, DVT were comparable to and not significantly higher than those in the control group making it a safe procedure to perform. CONCLUSION: Hence, a routine diagnostic laparoscopy is advocated for all patients of carcinoma stomach without evidence of metastatic disease by conventional imaging modalities