Laparoscopic staging of gastrointestinal tumours [editorial]

J M Schiappa
Giornale di Chirurgia - Journal of Surgery  
Proper staging of digestive oncologic diseases is defined as being a crucial step for the correct management of those problems. Only with a complete knowledge of the staging of the disease can the appropriate treatment be applied, be it surgical or medical. Many of the approaches for this pre-operative (or "non operative") staging are based in imaging exams that have shown, up till now, some degree of failure in its results. This is due to a lack of definition, both in dimensions and in
more » ... y. The technical characteristics of the equipment have seen a constant improvement but we are still far from having these definitions given only by imaging. Although laparoscopic US was first mentioned in 1963 (1), the first reference to the use of laparoscopy for staging is from 1971 (2). In 1986, some more interest was shown and it started, as well, to show some diagnostic superiority (3) The rationale for staging is based in the knowledge of the correct TNM stage. Obtaining in due time adequate information that would allow the application of the most appropriate therapy does this. On the other hand, we can also obtain a better prognosis for the situation; a correct staging allows R0 resections with a supposedly more appropriate management of the situation. This also offers better QoL for the patient, avoiding more aggressive procedures, eventually unnecessary, and giving some shortening in the hospital length of stay. Over-staged tumours have under-treatment by having a management which is not aggressive enough or is not even applied; on the other hand, under-staged tumours will have over-treatment, with too many non-radical surgeries being performed or with patients undergoing unnecessary laparotomies. Another question has to do with the laparoscopic approach. Why shall it be laparoscopic? Several factors are already well known enough as to justify this: It is less aggressive and allows better management of QoL, also diminishing post-operative pain and discomfort; early identification of eventual lesions non visualized during the pre-op staging is possible in an easy way and a more adequate management of diagnosis and therapeutic measures is achieved, allowing at the same time the execution of palliative procedures. It is necessary to have perfectly clarified the notion that none of these attitudes goes without a very thorough workout of the usual steps in patient diagnosis: clinical history, laboratory and observation data, imaging exams, endoscopies, CT scans and MNRs, trans-abdominal and endoscopic ultrasonographies, scintigraphies and FDG-PET, as well as other exams are mandatory to have the overview of the patient as complete as possible, before going to the surgical staging. With a carefully applied surgical technique, delicate and often lengthy, always with the use of 389
pmid:15018404 fatcat:iyca7lafs5cedfun2m4jk6qvyq