Laparoscopia de Estadificación en el Cáncer Gástrico

Laparoscopia de Estadificaciónen el Cáncer Gástrico:Situación actual y Perspectivas futuras

Staging Laparoscopy in Gastric Cancer: Current Status and future perspectives

M. García-Nebreda*,**, A. León Bretscher*, M. Ramírez Bescós*,
P. Gadea Uría*, E. Marqués Medina*, G. Paseiro Crespo*,**

* Servicio de Cirugía General, Aparato Digestivo. Hospial Infanta Leonor,
** Departamento de Cirugía. Universidad Complutense de Madrid,

DOI: https://doi.org/10.14679/4562

Resumen:

El cáncer gástrico es una de las neoplasias más frecuentes y letales a nivel mundial, con la mayoría de los casos diagnosticados en estadios avanzados. La estadificación precisa es fundamental para seleccionar la estrategia terapéutica más adecuada y evitar tratamientos innecesarios. Los métodos de imagen convencionales, como la tomografía computarizada TC) y la PETTC, presentan limitaciones en la detección de metástasis peritoneales y ganglionares ocultas, especialmente en tumores de histología difusa.
La laparoscopia de estadificación se ha consolidado como una herramienta diagnóstica clave, ya que permite detectar metástasis peritoneales en hasta un 19% de los pacientes considerados resecables por imagen. Sin embargo, existen controversias sobre sus indicaciones, el protocolo técnico y la realización sistemática de citología peritoneal. Las principales guías internacionales recomiendan su uso en pacientes con cáncer gástrico resecable, pero difieren en los criterios específicos y en el nivel de evidencia.
El procedimiento implica una exploración sistemática de la cavidad abdominal, con especial atención a la detección de lesiones peritoneales y la obtención de muestras para citología. La técnica es segura, con una baja tasa de complicaciones 0.4%), siendo las más frecuentes las infecciones superficiales y el sangrado.
Perspectivas futuras incluyen el uso de verde de indocianina para mejorar la detección de metástasis y la integración de inteligencia artificial para optimizar la estadificación. En conclusión, la laparoscopia de estadificación es una técnica eficaz y segura, aunque requiere estandarización para maximizar su impacto clínico.
Palabras Clave: Carcinomatosis peritoneal; laparoscopia de estadificación; estadificación tumoral; cáncer gástrico.

Abstract:

Gastric cancer is one of the most frequent and lethal neoplasms worldwide, with most cases diagnosed at advanced stages. Accurate staging is essential to select the most appropriate therapeutic strategy and avoid unnecessary treatments. Conventional imaging methods, such as computed tomography CT) and PET-CT, have limitations in detecting occult peritoneal and lymph node metastases, especially in tumors with diffuse histology.
Staging laparoscopy has become a key diagnostic tool, allowing detection of peritoneal metastases in up to 19% of patients initially considered resectable by imaging. However, controversies remain regarding its indications, technical protocol, and the routine performance of peritoneal cytology. Major international guidelines recommend its use in patients with resectable gastric cancer but differ in specific criteria and level of evidence.
The procedure involves a systematic exploration of the abdominal cavity, with special attention to identifying peritoneal lesions and obtaining samples for cytology. The technique is safe, with a low complication rate 0.4%), most commonly superficial infections and bleeding.
Future perspectives include the use of indocyanine green to enhance metastasis detection and the integration of artificial intelligence to optimize staging. In conclusion, staging laparoscopy is an effective and safe technique, although standardization is needed to maximize its clinical impact.

Key words: peritoneal carcinomatosis; staging laparoscopy; tumor staging; gastric cancer.

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