Dynamic CT in the preoperative evaluation of patients with gastric cancer: correlation with surgical findings and pathology.

摘要

BACKGROUND: The use of diagnostic techniques in the preoperative staging of patients with gastric cancer must be better defined. To further clarify which technique is indicated, we applied a new modality of computed tomography (CT) scanning for patients with gastric cancer. METHODS: Dynamic CT of the abdomen using water as oral contrast agent was performed in 30 patients with gastric adenocarcinoma. Patients without evidence of metastatic disease underwent exploratory laparotomy and intraoperative staging. Resectable patients had surgical excision and definitive pathologic staging. RESULTS: Two patients (7%) had metastatic disease by CT and were considered inoperable. The remaining 28 underwent laparotomy. Of these, six (21%) were unresectable and 22 (79%) had surgical resection. Dynamic CT adequately suggested advanced stage disease in four (67%) of the 6 unresectable patients. Wall thickness in dynamic CT correlated with the risk of serosal involvement (P < .001). Both CT and surgery had an accuracy of 64% (P > .05) in predicting pathologic staging. CT overstaged only 4% of cases. CONCLUSIONS: Dynamic CT is a useful modality that can indicate inoperable disease, obviating the need for laparotomy in patients with gastric adenocarcinoma. CT can modify the surgical approach by suggesting unresectable or advanced disease. The low percentage of patients that are overstaged by CT, combined with its similar staging accuracy when compared with laparotomy, support its preoperative use in these patients.