Preoperative Evaluation of Gastric Cancer: Is it Discordant with Postoperative Staging?

Gastric cancer is one of the most common human cancers worldwide. Preoperative knowledge of adjacent organ invasion and distant metastasis is important in planning the operative procedure, allowing the surgeon to decide whether surgery is potentially curative or palliative in nature. Computed tomography is an imaging modality used for preoperative staging. The aim of this study was to evaluate and explore any discordance between pre- and postoperative staging of gastric cancer by comparing the imaging findings with post-operative histopathological findings. This longitudinal observational study was conducted in the department of surgery, Chittagong Medical College and Hospital, Chattogram, Bangladesh. Histopathologically confirmed gastric adenocarcinoma patients were included. Detail history taking, relevant clinical examination, preoperative staging, multidisciplinary team meeting, intraoperative findings with peritoneal lavage and postoperative histopathological examination were done to determine any disparity or discordance between pre- and post-operative staging of gastric cancer. The mean age of the patient was 54.30 ±12.60 (Mean ± SD) years. Male-female ratio was 1.37:1. Preoperative staging with CT scan showed that 54 patients (52.94%) were T3 stage, and 56 patients (54.90%) were N0 stage. Curative operation was done in 69.60% patients. Intraoperative findings showed that in 40 patients (39.2%) tumors extended to surrounding structure, 41 patients (40.2%) had lymph node involvement, 23 patients (22.5%) had ascites, 20 patients (19.6%) had distal metastases, and liver is the most common site (10 patients, 9.8%). Peritoneal lavage cytology was positive in 18 patients (17.6%). Pre- operative and post-operative staging were discordance in all T and N stages. Overall sensitivity of T stage was 97% and specificity was 100%. Overall sensitivity of N staging was 51% and specificity was 100%. Pre- and post-operative staging of gastric cancer shows that there is discor