The Necessity of Staging Laparoscopy/Thoracoscopy in Patients Undergoing Thoracolaparoscopic Oesophagogastric Resections for Malignancy

摘要

The benefit of thoracolaparoscopy in the staging algorithm for patients with upper gastrointestinal malignancies is considered to be valuable. The impact of modern staging modalities on the need for staging thoracolaparoscopy is unclear. Here we assess the possible role of diagnostic thoracolaparoscopy in preoperative staging of oesophagogastric cancer. No pure gastric lesion included in the study. We have included 102 cases of esophagogastric junction and 86 lower esophagus. Staging thoracolaparoscopy was carried out for 188 consecutive patients who were considered for curative oesophagogastric resection and had undergone complete set of staging invitation. In our study, 188 patients with oesophagogastric cancer had staging thoracolaparoscopy. The mean operative time was 43.9 minutes. Overall staging thoracolaparoscopy had changed treatment decision in 23/188 patients (12.2%) where no further curative resection was attempted due to involvement of peritoneum in 18 patients (9.6%), omentum in 14patients (7.4%), liver in 11 patients (5.9%) and fixation of the stomach in 17patients (9%).We concluded that staging thoracolaparoscopy should be used for patients with esophageal cancer who are potential candidates for curative surgical resection based on a negative preoperative staging for lymph node or distant metastases Staging thoracolaparoscopy is very necessary and found to be safe and useful in detecting peritoneal, omental and liver disease despite negative staging modalities. No further curative resection was attempted due to involvement of the peritoneum, omentum, liver, and fixation of the stomach.