Laparoscopic Lymph Node Assessment in Pretherapeutic Staging of Gastric and Esophageal Cancer

Abstract

In gastric cancer lymph node metastases at the hepatoduodenal ligament and in esophageal cancer, metastases at the celiac axis are classified as distant metastases (M1 LYMPH) and implying a poor prognosis. In pretherapeutic staging, imaging procedures such as computed tomography of the abdomen or transcutaneous ultrasonic examination are of limited value in the assessment of enlarged or metastatic lymph nodes. Conversely, laparoscopic staging with subsequent biopsy of suspicious lymph nodes provides essential diagnostic information.

After exclusion of distant metastases (liver, lung, bone) in 73 patients with esophageal- (n = 21) and gastric cancer (n = 52), staging laparoscopy, including laparoscopie ultrasound, were performed during an 18-month-period (July/ 93–December/94). After laparoscopie exclusion of peritoneal seedings, the hepatoduodenal ligament was examined and enlarged lymph nodes were biopsied

In a total of 73 patients, laparoscopy revealed previously undiagnosed liver metastases in 14 and peritoneal carcinosis in 19 patients. Additionally, in eight (esophageal cancer; n = 3, gastric cancer; n = 5) of the remaining 40 patients, lymph nodes in the Ml-position were regarded suspicious and biopsied. In six of these, malignant spread was observed. Thus, in a further six of 40 patients, surgically incurable situations could be detected.

In esophageal and gastric cancer, staging laparoscopy, including laparoscopic ultrasound and biopsy, is a sensitive technique to assess local tumor spread and distant metastases. The detection of M1- lymph node metastases is facilitated by the use of laparoscopie ultrasound. Tumor spread, which limits surgical curability, can be properly assessed and exploratory laparotomy avoided.