| Objective: To determine the clinical value of abdominal enhanced-contrast spiral CT and laparoscopic exploration for advanced gastric cancer in preoperative TNM staging and surgical method.Methods: A total of 80 patients with advanced gastric cancer who underwent both enhanced-contrast spiral CT and laparoscopic exploration before operation were enrolled.enhanced-contrast spiral CT and laparoscopic exploration findings regarding TNM staging and surgical method were correlated with surgical and pathological findings.Results: The accuracy of enhanced-contrast spiral CT and laparoscopic exploration with CT for staging advanced gastric cancer was 69.0%(20/29), 82.8%(31/40)for T2; 75.0%(30/40), 85.0%(34/40) for T3; 63.6%(7/11), 90.1%(10/11) for T4; the accuracy of total T staging was 71.3%(57/80) 86.3%(69/80), respectively. The accuracy for N staging was 68.0%(17/25), 80.0%(20/25)for N0; 75.9%(22/29), 86.2%(25/29) for N1; 64.3%(9/14), 64.3%(9/14) for N2; 75.0%(3/4),75.0%(3/4) for N3. The total accuracy, sensitivity and specificity of N staging was 70.5%, 76.2%,76.9%; 82.1%, 89.4%, 92.5%, respectively. For M staging, the patients with obvious distant metastasis was excluded by enhanced-contrast spiral CT, so we just compared laparoscopic exploration with pathological findings, the accuracy of M staging was 92.9%(65/70) for M0,70.0%(7/10) for M1; When surgical methods were considered to be the outcome, the accuracy of enhanced-contrast spiral CT and laparoscopic exploration was 81.3%(65/80), 95.0%(76/80),respectively.Conclusions: Combined enhanced-contrast spiral CT and laparoscopic exploration is useful for TNM staging of gastric cancer and for predicting excision range and surgical methods, especially in evaluating peritoneal metastasis, liver micrometastasis, serosa invasion. |
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