Diagnostic laparoscopy: indications and benefits.
BACKGROUND
The increased availability of treatment options for gastrointestinal cancer, necessitates precise preoperative staging. Laparoscopy can be useful for establishing the diagnosis and staging of cancer. However, there is an ongoing discussion as to whether staging laparoscopy provides additional results despite newly developed imaging tools.


METHODS
A systematic review of relevant literature was undertaken. The strength of evidence was classified according to the North of England Evidence Based Guidelines Development Project. Medline and manual searches were carried out to identify all published manuscripts of clinical trials that dealt with staging laparoscopy. Systematic quality review of those publications was used to verify staging accuracy, complications and trocar metastases.


RESULTS
Only one randomized trial was performed in gynaecological cancer. In cervical cancer, as a result of this study, staging laparoscopy remains unproven. In gastrointestinal cancer (oesophageal, gastric, pancreatic, liver and colorectal cancers) only prospective and retrospective observational studies are available with an evidence-based level of grade B. As a result of these trials, staging laparoscopy, in a well-defined group of patients with locally advanced cancer, is recommended.


CONCLUSIONS
The effects of surgical staging in gynaecological cancer must be kept in mind but cannot be transferred to gastrointestinal cancer in general. Further studies are required to answer those questions.
Rau
Beate
B
Charité, Campus Berlin Buch, Klinik für Chirurgie und chirurgische Onkologie, Robert Rössle Klinik im Helios-Klinikum Berlin, Universitätsmedizin Berlin, 13122, Berlin, Germany. rau@rrk.charite-buch.de
Hünerbein
Michael
M
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery