Unplanned laparoscopic peritoneal biopsy for gastric cancer

INTRODUCTION: It is thought that the sensitivity of computed tomography (CT) in detecting peritoneal metastases (PM) is low. In this study, we aimed to present our experience on gastric cancer (GC) patients with intraoperatively detected PM whose preoperative CT was normal in terms of distant metastasis.
METHODS: We retrospectively analyzed the demographics and perioperative data of ten patients with gastric adenocarcinoma whose preoperative CT was normal in terms of PM, but intraoperatively PM was detected.
RESULTS: The mean age of the patients was 68.30±9.44 years. Six patients (60%) were male. Tumors were mostly localized in the distal 1/3 of the stomach (n=5, 50%). The median carcinoembryonic antigen and carbohydrate antigen 19.9 levels were 2.00 ng/ml (0.60–37.50) and 30.76 IU/ml (3.28–449.30), respectively. There were PM on the visceral peritoneum (small bowel mesentery) in two patients (20%) and on the parietal peritoneum in eight patients (80%). The operations were terminated in five patients (50%) when the PM detected as they did not have any complications due to cancer. Laparoscopic feeding jejunostomy (n=2, 20%), laparoscopic tube gastrostomy (n=1, 10%), and laparoscopic gastroenterostomy (n=2, 20%) were performed on the patients with oral intake deficiency due to GC.
DISCUSSION AND CONCLUSION: Preoperative staging with CT before GC surgery is still valid. Multidetector CT scan should be preferred. However, it is still not enough for detecting all PM before surgery. Staging laparoscopy should be in mind, especially for patients with a high risk of PM.