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South West Public Health Observatory UPPER GI CANCER LAPAROSCOPY AND ENDOLUMINAL ULTRASOUND STAGING AUDIT ACROSS FIVE CANCER NETWORKS DR Bailey1([email protected]) and M Vipond2 on behalf of the SWCIS Upper GI Tumour Panel 1SWPHO Cancer Intelligence Service (SWCIS), 2Gloucestershire Royal Hospital Introduction Results Conventional CT scanning for the staging of oesophagogastric cancer is of limited value in determining local or nodal invasion either of which may preclude surgical resection. Abdominal laparoscopy has been shown in a number of studies to offer additional staging information, when curative surgical resection is a therapeutic option: Twenty one of the twenty six trusts responded (81%). Ten units had a written protocol for EUS and laparoscopic staging. All eight specialist units performed laparoscopic staging, as did eight diagnostic units. Only six units performed EUS. Assessment of local or nodal spread : Transcoelomic spread including peritoneal metastases : Liver metastasis : Additionally further biopsies may be obtained This is because peritoneal spread of tumours is difficult to detect with conventional imaging such as CT and EUS. Laparoscopy is generally used in patients with gastric or oesophagogastric junction tumours. It is important for patients in whom chemotherapy is contemplated either in a neoadjuvant role or to downstage disease,which at initial staging appears inoperable. It should be used in selected cases, where there is suspicion of peritoneal spread on conventional CT imaging or EUS. Endoluminal ultrasound (EUS) is also reported to provide additional staging information with approximately 90% accuracy: Tumour stage : Local node stage Both modalities are recommended for routine use in the clinical outcomes guidance for Oesophagogastric cancer1 1.Improving Outcomes Guidance in Upper Gastro-intestinal Cancers Department of Health January 2001. For oesophageal and junctional tumours, reports were received for 185 patients. EUS was undertaken in 44%; laparoscopy in 27%. The majority of patients not undergoing these investigations had advanced disease on CT or co-morbidity. The lower use of laparoscopy reflected some units not employing laparoscopy for oesophageal cancer, particularly upper and middle third tumours. For gastric cancer, reports were received for 167 patients. EUS was performed in 5%; laparoscopy in 38%. Advanced disease on CT or co-morbidity was the main reason for non use. EUS was not part of the protocol for gastric cancer in 22%. Number of resections dependant on modality of staging for Oesophageal and Junctional cancers EUS LAPAROSCOPY 38 (12 resections) 43 7 (26 resections) (2 resections) 97 NEITHER R (0 resections 1 open & close) Number of resections dependant on modality of staging for Gastric cancers EUS Aims and objectives Conclusions To identify current protocols for staging EUS and laparoscopy performed for oesophagogastric cancer in the region covered by the South West Cancer Intelligence Service (SWCIS) To identify actual practice in a cohort of oesophageal and gastric cancer patients Differences in the use of EUS and laparoscopy between centres cannot be explained by initial CT staging and comorbidity. Cancer Networks should unify their policy for staging EUS and laparoscopy with a written protocol that specifies indications and timing in the patient pathway. National guidelines for the use of EUS and laparoscopy, published in 20011, may now be outdated and further evaluation and updated guidance helpful. Methods In 2005, three questionnaires were circulated to all upper GI cancer leads in twenty six trusts in five Cancer Networks. The first questionnaire investigated protocols for EUS and laparoscopic staging. The other two questionnaires examined actual staging practice for the last ten patients diagnosed with oesophageal and gastric cancer in each trust prior to August 2005. www.swpho.nhs.uk LAPAROSCOPY 7 2 (1 resection) (5 resections 1 open & close) 101 NEITHER (6 resections) 8 bypass) 57 (29 resections)