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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2005 February;18(1):7-14
The preoperative staging of gastric cancer
Sansonna F., Maggioni D., Pauna J., Gambitta P., Perego R., Scandroglio I., Di Lernia S., Ferrari G. C., Magistro C., Pugliese R.
The staging of gastric cancer in the preoperative span must deal with different situations in the Italian context like in other European countries. In the vast majority of suburban hospitals, diagnostic tools such as helical CT or ultrasound endoscopy are not available and conventional CT is routinely performed. Hence, 2 levels of staging were identified with different steps to follow, according both to the availability of diagnostic tools and to therapeutic perspectives offered by surgical and oncological teams on the spot. Basically, the preoperative staging of gastric cancer should include endoscopy with biopsy and vital staining, especially in order to detect more early gastric cancers (EGC). Endoscopy with biopsy and staining are recommended since they are available in every suburban situation. Echography with conventional or helical CT complete the basic level of staging in gastric cancer. Among the imaging techniques, helical CT can reach the best sensitivity as far as hepatic metastases and peritoneal carcinosis are concerned. With conventional CT the sensitivity for peritoneal carcinosis is much lower than with helical CT. A more detailed level of staging in gastric cancer is represented by echoendoscopy, diagnostic laparoscopy and echolaparoscopy. Ultrasound endoscopy examination is very useful for confirmation of diagnosis of EGC, as it can reach 100% of accuracy for T1 with 15 MHz probes in the literature, so that it is essential in those centers where laparoscopy gastric surgery for EGC is performed. Diagnostic laparoscopy and echolaparoscopy are essential in those centers where intraperitoneal adjuvant chemotherapy is carried out in T3 and T4 gastric tumors.