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

Abstract

PurposeBefore 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).MethodsIn 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).ResultsPT, 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).ConclusionEndoscopic 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.

Real‐time detection system for tumor localization during minimally invasive surgery for gastric and colon cancer removal: In vivo feasibility study in a swine model

“…In addition, magnetometry uses magnets during the operation, and requires a highly sensitive magnetometer . Computed tomography gastroscopy allows the preoperative estimation of the tumor position, but this method is unable to accurately localize the tumor in real‐time during surgery …”

“…12 Computed tomography gastroscopy allows the preoperative estimation of the tumor position, but this method is unable to accurately localize the tumor in real-time during surgery. 13 To overcome the limitations of these localization methods, recent studies have utilized RFID technology. The combination of RFID tags and a handheld RFID detector shows promise for preoperative imaging-guided tumor localization.…”

“…Various methods to address this issue have been evaluated, including endoscopic tattooing, intraoperative gastroscopy, endoscopic clipping with intraoperative radiography, ultrasonography or magnetometry, and computed tomography gastroscopy . However, these methods still have limitations.…”

“…Various methods to address this issue have been evaluated, including endoscopic tattooing, intraoperative gastroscopy, endoscopic clipping with intraoperative radiography, ultrasonography or magnetometry, and computed tomography gastroscopy. [5][6][7][8][9][10][11][12][13] However, these methods still have limitations. Recent studies have begun to develop and evaluate marking systems based on radio frequency identification (RFID) technology.…”

Development of a non-blurring, dual-imaging tissue marker for gastrointestinal tumor localization

“…Accordingly, the routine preoperative assessment of gastric cancer generally includes both esophagogastroendoscopy and X-ray CT examinations. However, assessing the locations of tumors using a gastroendoscope can be inaccurate [23], and early gastric cancer lesions are barely visible on X-ray CT images [24]. Thus, dual-imaging (DI) tissue markers that are preoperatively administered around early gastric cancer lesions could assist with both preoperative surgical simulations and intraoperative navigation using NIR fluorescence laparoscopy.…”