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

Hemanth Kumar Singh; T. P. Elamurugan; G. S. Sreenath; Vishnu Prasad N. R.

doi:10.18203/2349-2902.isj20164418

Authors

Hemanth Kumar Singh Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
T. P. Elamurugan Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
G. S. Sreenath Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Vishnu Prasad N. R. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

DOI:

https://doi.org/10.18203/2349-2902.isj20164418

Keywords:

Carcinoma, Gastric cancer, Peritoneal metastasis, Peritoneal nodules

Abstract

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.

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References

Gupta SK, Gupta R, Singh G. Perforation peritonitis: a two year experience. J Med Education Res. 2010;12(3):141-44.

Pai D, Sharma A, Kanungo R. Role of abdominal drains in perforated duodenal ulcer patients: a prospective controlled study. Aust NZJ Surg. 1999;69:210-3.

Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg. 2009;33(8):1600-4.

Behrman SW. Management of complicated peptic ulcer disease. Arch Surg. 2005;140:201-8.

Post PN, Kuipers EJ, Meijer GA. Declining incidence of peptic ulcer but not of its complications: a nation-wide study in The Netherlands. Aliment Pharmacol Ther. 2006;23:1587-93.

Shinagawa N, Muramoto M, Sakurai S. A bacteriological study of perforated duodenal ulcers. Jpn J Surg. 1991;21:1-7.

Fong IW. Septic complications of perforated peptic ulcer. Can J Surg. 1983;26:370-2.

Chandramaliteeswaran C, Srinivasan K, Kadambari D. An audit of secondary bacterial peritonitis with special reference to peritoneal fluid culture.

Ng EK, Lam YH, Sung JJ. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231:153-8.

Gupta S, Kaushik R, Sharma R. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15.

Taleb AK, Razzaq RA, Kathiri ZO. Management of perforated peptic ulcer in patients at a teaching hospital. Saudi Med J. 2008;29:245-50.

Pramod J, Srinivasan K. Detection of candida in intra operative peritoneal specimen in perforation peritonitis and its significance on the outcome of the patient. 2013.

13.Taha AS, Angerson WJ, Prasad R. Clinical trial: the incidence and early mortality after peptic ulcer perforation, and the use of low-dose aspirin and nonsteroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2008;28:878-85.

Boey J, Lee NW, Koo J. Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial. Ann Surg. 1982;196:338-44.

Berne TV, Donovan AJ. Non operative treatment of perforated duodenal ulcer. Arch Surg. 1989;124:830-2.

Blomgren LG. Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg. 1997;21:412-4.

Griffin GE, Organ CH. The natural history of the perforated duodenal ulcer treated by suture plication. Ann Surg. 1976;183:382-5.

Jordan GL, De ME, Duncan JM. Surgical management of perforated peptic ulcer. Ann Surg. 1974;179:628-33.

Risk factors and Mannheim peritonitis index for the prediction of morbidity and mortality in patients with peptic ulcer perforation. Available at http:// www. nobelmedicus. com/ contents/ 200953/74-81.htm. Accessed on 16 November 2013.

Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer. 2012;12:26-35.

Sharma SS, Mamtani MR, Sharma MS, Kulkarni H. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer. BMC Surg. 2006;6:8.

Barut I, Tarhan OR, Cerci C, Karaguzel N, Akdeniz Y, Bulbul M. Prognostic factors of peptic ulcer perforation. Saudi Med J. 2005;26:1255-9.

Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33:80-5.

Larkin JO, Bourke MG, Muhammed A, Waldron R, Barry K, Eustace PW. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study. Ir J Med Sci. 2010;179:545-9.

Scott HW, Sawyers JL, Gobbel WG, Herrington JL. Definitive surgical treatment in duodenal ulcer disease. Curr Probl Surg. 1968;1:56-8.

Testini M, Portincasa P, Piccinni G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol. 2003;9:2338-40.

Schein M. Perforated peptic ulcer. In: Schein M, Rogers PN, eds. Schein’s common sense emergency abdominal surgery, 2nd edition. Berlin Heidelberg: Springer-Verlag. 2004;143-50.