Efficacy of contrast enhanced computed tomography and diagnostic laparoscopy in detecting unsuspected peritoneal metastasis in gastric carcinoma

Background: Gastric cancer remains the second most common cause of death from cancer worldwide. Peritoneal metastasis is the most frequent pattern of disease failure after curative resection of gastric cancer. Detection of these deposits and free cancer cells are necessary for predicting the risk of recurrence and prognostication. Methods: The study was conducted in Department of Surgery from October 2011 to July 2013. The study was designed as a prospective comparative study. All the patients diagnosed with gastric cancer by upper gastrointestinal endoscopy guided biopsy and not having clinical and / or radiological evidence of distant metastasis were included in the study. All patients underwent contrast enhanced computed tomography pre-operatively to detect metastatic disease or advanced gastric cancer. Subsequently the patients were planned for diagnostic laparoscopy followed by appropriate surgery. Sensitivities of the procedure in detecting peritoneal metastases was calculated and compared. Results: A total of 35 gastric cancer patients who met the inclusion and exclusion criteria were recruited in the study. The mean age of these patients was 53.5 years. Diagnostic laparoscopy detected 11 cases of metastatic diseases which were not picked up by CECT, which was statistically significant (p <0.05). Diagnostic laparoscopy showed adjacent organ infiltration in 18 patients, 9 of which were also identified on CT scan. Difference in detection of adjacent organ infiltration was not statistically significant. Infiltration of the serosal surface was seen in 31 patients and 9 of them were identified on CECT scan. Conclusions: Diagnostic laparoscopy is more sensitive and specific than current generation MDCT in detecting peritoneal metastasis and liver surface nodules in cases of gastric cancer. Diagnostic laparoscopy is also more specific in diagnosing the local infiltration into adjacent organs.

[1]  E. Jung,et al.  Analysis of Risk Factors for Postoperative Morbidity in Perforated Peptic Ulcer , 2012, Journal of gastric cancer.

[2]  J. Larkin,et al.  Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study , 2010, Irish journal of medical science.

[3]  M. Schein.  Perforated Peptic Ulcer , 2010 .

[4]  S. Gupta,et al.  Perforation Peritonitis:A Two Year Experience , 2010 .

[5]  D. Kadambari,et al.  Perforated Peptic Ulcer in South India: An Institutional Perspective , 2009, World Journal of Surgery.

[6]  W. Angerson,et al.  Clinical trial: the incidence and early mortality after peptic ulcer perforation, and the use of low‐dose aspirin and nonsteroidal anti‐inflammatory drugs , 2008, Alimentary pharmacology & therapeutics.

[7]  R. Razzaq,et al.  Management of perforated peptic ulcer in patients at a teaching hospital. , 2008, Saudi medical journal.

[8]  V. Lohsiriwat,et al.  Perforated Peptic Ulcer: Clinical Presentation, Surgical Outcomes, and the Accuracy of the Boey Scoring System in Predicting Postoperative Morbidity and Mortality , 2008, World Journal of Surgery.

[9]  H. Kulkarni,et al.  A prospective cohort study of postoperative complications in the management of perforated peptic ulcer , 2006, BMC surgery.

[10]  G. Meijer,et al.  Declining incidence of peptic ulcer but not of its complications: a nation‐wide study in The Netherlands , 2006, Alimentary pharmacology & therapeutics.

[11]  K. Hori,et al.  A bacteriological study of perforated duodenal ulcers , 2006, The Japanese journal of surgery.

[12]  İ. Barut,et al.  Prognostic factors of peptic ulcer perforation. , 2005, Saudi medical journal.

[13]  Rajeev Sharma,et al.  The management of large perforations of duodenal ulcers , 2005, BMC surgery.

[14]  S. Behrman.  Management of complicated peptic ulcer disease. , 2005, Archives of surgery.

[15]  MarioTestini,et al.  Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer , 2003 .

[16]  J. Sung,et al.  Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. , 2000, Annals of surgery.

[17]  A. Gupta,et al.  Role of abdominal drains in perforated duodenal ulcer patients: a prospective controlled study. , 1999, The Australian and New Zealand journal of surgery.

[18]  L. Blomgren.  Perforated Peptic Ulcer: Long-term Results after Simple Closure in the Elderly , 1997, World Journal of Surgery.

[19]  Hironobu Ito,et al.  Non-operative treatment of perforated duodenal ulcer , 1995 .

[20]  Fong Iw.  Septic complications of perforated peptic ulcer. , 1983 .

[21]  J. Boey,et al.  Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial. , 1982, Annals of surgery.

[22]  G. Griffin,et al.  The Natural History of the Perforated Duodenal Ulcer Treated by Suture Plication , 1976, Annals of surgery.

[23]  J. M. Duncan,et al.  Surgical Management of Perforated Peptic Ulcer , 1974, Annals of surgery.

[24]  H. Scott,et al.  Definitive surgical treatment in duodenal ulcer disease. , 1968, Current problems in surgery.