What studies are appropriate and necessary for staging gastric adenocarcinoma? Results of an international RAND/UCLA expert panel. Academic Article uri icon

Overview

abstract

  • BACKGROUND: The approach for staging gastric adenocarcinoma (GC) has not been well defined, with heterogeneity in the application of staging modalities. METHODS: Utilizing a RAND/UCLA appropriateness methodology (RAM), a multidisciplinary expert panel of 16 physicians scored 84 GC staging scenarios. Appropriateness was scored from 1 to 9. Median appropriateness scores from 1 to 3 were considered inappropriate, 4-6 uncertain, and 7-9 appropriate. Agreement was reached when 12 or more of 16 panelists scored the scenario similarly. Appropriate scenarios were subsequently scored for necessity. RESULTS: Pretreatment TNM stage determination is necessary. Necessary staging maneuvers include esophagogastroduodenoscopy (EGD); biopsy of the tumor; documentation of tumor size, description, location, distance from gastroesophageal junction (GEJ), and any GEJ, esophageal, or duodenal involvement; if an EGD report is unclear, surgeons should repeat it to confirm tumor location. Pretreatment radiologic assessment should include computed tomography (CT)-abdomen and CT-pelvis, performed with multidetector CT scanners with 5-mm slices. Laparoscopy should be performed before resection of cT3-cT4 lesions or multivisceral resections. Laparoscopy should include inspection of the stomach, diaphragm, liver, and ovaries. CONCLUSIONS: Using a RAM, we describe appropriate and necessary staging tests for the pretreatment staging evaluation of GC, as well as how some of these staging maneuvers should be conducted.

authors

  • Coit, Daniel
  • Dixon, Matthew
  • Cardoso, Roberta
  • Tinmouth, Jill
  • Helyer, Lucy
  • Law, Calvin
  • Swallow, Carol
  • Paszat, Lawrence
  • McLeod, Robin
  • Seevaratnam, Rajini
  • Mahar, Alyson
  • Coburn, Natalie G

publication date

  • April 30, 2013

Research

keywords

  • Adenocarcinoma
  • Laparoscopy
  • Neoplasm Staging
  • Practice Guidelines as Topic
  • Specialties, Surgical
  • Stomach Neoplasms
  • Tomography, X-Ray Computed

Identity

Scopus Document Identifier

  • 84898771038

Digital Object Identifier (DOI)

  • 10.1007/s10120-013-0262-x

PubMed ID

  • 23633230

Additional Document Info

volume

  • 17

issue

  • 2