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USEFULNESS OF LAPAROSCOPIC NARROW-BAND IMAGING FOR THE EVALUATION OF THERAPEUTIC EFFECTS ON PERITONEAL METASTASIS IN GASTRIC CANCER
Hirotoshi Kikuchi^*, Kinji Kamiya, Sanshiro Kawata, Amane Hirotsu, Tomohiro Murakami, Tomohiro Matsumoto, Yusuke Ozaki, Yoshihiro Hiramatsu, Takanori Sakaguchi, Hiroyuki Konno, Hiroya Takeuchi
Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
Background: The peritoneum is one of the most frequent and lethal locations of recurrence in patients with advanced gastric cancer. As recent advances in chemotherapy improved prognosis of gastric cancer patients with peritoneal metastasis, accurate diagnosis of peritoneal metastasis has become more important for improving outcomes. However, it is difficult using conventional modalities such as computed tomography and positron emission tomography. Staging laparoscopy is often used to diagnose peritoneal metastasis in patients with advanced gastric cancer, but accurate detection of metastasis can be difficult. In this study, we evaluate the usefulness of laparoscopic narrow-band imaging (NBI) versus conventional laparoscopic white-light imaging (WLI) for the diagnosis of peritoneal metastasis and for the evaluation of therapeutic effect of chemotherapy on peritoneal metastasis in gastric cancer.
Methods: We excised 49 white nodules from the parietal peritoneum of 36 gastric cancer patients. Among them, 9 patients received chemotherapy for advanced or recurrent gastric cancer before staging laparoscopy, and 27 did not receive chemotherapy except for adjuvant chemotherapy with S-1. The WLI and NBI findings were compared with the pathological findings.
Results: All the peritoneal nodules examined were observed as white nodules on WLI. Intranodular vessels were evaluated by WLI and NBI for dilatation, tortuousness, heterogeneity, and brown spots. Detection of any one abnormal finding on NBI plus clear demarcation of the peritoneal nodules on WLI more properly diagnosed 38 peritoneal nodules of 27 patients who did not receive chemotherapy (sensitivity, 100%; specificity, 84.2%; accuracy, 92.1%). In contrast, diagnosis ability was poor for 12 peritoneal nodules of 9 patients who received chemotherapy before staging laparoscopy (sensitivity, 66.7%; specificity, 33.3%; accuracy, 58.3%). Three patients underwent laparoscopic NBI using 4K video imaging systems with a 55 inch monitor. Their peritoneal nodules with dilated vessels were more clearly visualized.
Discussion: Laparoscopic NBI was useful for the diagnosis of peritoneal metastasis before chemotherapy, and 4K imaging systems may contribute to more accurate diagnosis. The NBI findings of peritoneal metastasis could be affected by chemotherapy, depending on the effects on tumor stroma and independent of the disappearance of tumor cells. Disappearance of dilated vessels on laparoscopic NBI could be useful to evaluate the therapeutic effect and predict prognosis.
Conclusion: Laparoscopic NBI is a useful tool for the diagnosis of peritoneal metastasis in patients with advanced gastric cancer before chemotherapy, and may be used to diagnose the therapeutic effectiveness of chemotherapy.

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