J Korean Surg Soc.  2013 Feb;84(2):80-87. 10.4174/jkss.2013.84.2.80.

Effectiveness of endoscopic clipping and computed tomography gastroscopy for the preoperative localization of gastric cancer

Affiliations
  • 1Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea. yjleegnu@gmail.com
  • 2Gyeongnam Regional Cancer Center, Jinju, Korea.
  • 3Gyeongsang Institute of Health Sciences, Jinju, Korea.
  • 4Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea.
  • 5Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

Abstract

PURPOSE
Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap).
METHODS
In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis).
RESULTS
PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both).
CONCLUSION
Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy; X-ray computed tomography; Gastroscopy

MeSH Terms

Esophagogastric Junction
Gastrectomy
Gastroscopy
Humans
Laparoscopy
Prospective Studies
Pylorus
Stomach Neoplasms
Tomography, X-Ray Computed

Figure

  • Fig. 1 Preoperative clipping and preoperative measurements using a gastrofibroscope. (A) An endoscopic clip was placed proximal to the tumor. (B) The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the clip opposite the angle on the greater curvature and the gastroesophageal junction (lesser curvature, LC) were measured. GC, greater curvature.

  • Fig. 2 Preoperative measurements using a computed tomography (CT) scan. The endoscopic clips were readily detected by CT scans (A), which allowed the 3-dimensional image to be reconstructed. Distances between the pylorus and the clip proximal to the tumor, the angle clip, the clip placed opposite the angle on the greater curvature, and the gastroesophageal junction were measured (B).

  • Fig. 3 Intraoperative measurements with laparoscopy. The endoscopic clip on the serosa side was marked with Gentian Violet stain by a laparoscopic surgeon using a gastrofibroscope, and an operator using a Nelaton ruler measured the distances between the pylorus and the clip proximal to the tumor, the angle clip, the clip opposite the angle on the greater curvature, and the gastroesophageal junction.

  • Fig. 4 Postoperative measurement by visual inspection. The distances between the pylorus and the clip proximal to the tumor (PT), the angle clip (PA), and the clip opposite the angle on the greater curvature (GC), were measured after the operation.


Cited by  1 articles

The Role of Three-Dimensional Multidetector CT Gastrography in the Preoperative Imaging of Stomach Cancer: Emphasis on Detection and Localization of the Tumor
Jin Woong Kim, Sang Soo Shin, Suk Hee Heo, Hyo Soon Lim, Nam Yeol Lim, Young Kyu Park, Yong Yeon Jeong, Heoung Keun Kang
Korean J Radiol. 2015;16(1):80-89.    doi: 10.3348/kjr.2015.16.1.80.


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