Il trattamento laparoscopico dell'ulcera duodenale perforata

The growing role of multimodal treatment plans for advanced gastric cancer has contributed to the development of more accurate preoperative staging strategies. The high diagnostic efficacy of video-laparoscopy as regards the M factor has been reported by many; preoperative laparoscopy therefore permits to avoid unhelpful surgical exploration in case of peritoneal dissemination of tumor or liver metastases undetected by conventional staging. At Memorial Sloan Kattering Cancer Center preoperative staging laparoscopy is currently included in the diagnostic algorithm for gastric cancer. Data from a consecutive series of 103 patients demonstrated metastatic disease in 24 patients (37%) who were considered to have localized cancer by computed tomography (CT) or endoscopic ultrasonography (EUS), with an accuracy of 94% with respect to the M factor. These patients did not require open surgery. Laparoscopic washings were obtained from 127 patients with gastric cancer and a positive correlation between the extent of disease and prevalence of positive cytology was noted (T1/T2: 0%, T3/T4: 10%, M+: 59%). Our experience suggests that laparoscopy has added value in staging patients with gastric carcinoma. It appears to be a safe and effective staging modality, avoiding unnecessary explorations and providing new means of directing appropriate tretament strategy.