title: A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer.
abstract: BACKGROUND
  Despite improved preoperative imaging techniques, patients with incurable or unresectable gastric cancer are still subjected to non-therapeutic laparotomy. Diagnostic laparoscopy (DL) has been advocated by some to be essential in decision-making in gastric cancer. We aimed to identify and synthesize findings on the value of DL for patients with gastric cancer, in this era of improved preoperative imaging.
  
  
  METHODS
  Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. We calculated the change in management and avoidance of laparotomy based on the addition of DL and laparoscopic ultrasound (LUS). The accuracy, agreement (kappa), sensitivity, and specificity of DL in assessing tumor extent, nodal involvement, and the presence of metastases with respect to the gold standard (pathology) were also calculated.
  
  
  RESULTS
  Twenty-one articles were included. DL showed moderate to substantial agreement with final pathology for T stage, but only fair agreement for N stage. For M staging, DL had an overall accuracy, sensitivity, and specificity ranging from 85-98.9%, 64.3-94%, and 80-100%, respectively. The use of DL altered treatment in 8.5-59.6% of cases, avoiding laparotomy in 8.5-43.8% of cases. LUS provided additional benefit in 5.8-7.2% of cases.
  
  
  CONCLUSIONS
  Despite evolving preoperative imaging techniques, diagnostic laparoscopy continues to be of substantial value in staging patients with gastric cancer and in avoiding unnecessary laparotomy. The current data support DL for all patients with advanced gastric cancer.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Pierre-Anthony
authors.initials: PA
authors.lastname: Leake
authors.forename: Roberta
authors.initials: R
authors.lastname: Cardoso
authors.forename: Rajini
authors.initials: R
authors.lastname: Seevaratnam
authors.forename: Laercio
authors.initials: L
authors.lastname: Lourenco
authors.forename: Lucy
authors.initials: L
authors.lastname: Helyer
authors.forename: Alyson
authors.initials: A
authors.lastname: Mahar
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
mesh_terms: D003657:Decision Making; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery