title: The role of laparoscopy and laparoscopic ultrasound in the preoperative staging of patients with resectable colorectal liver metastases: a meta-analysis.
abstract: BACKGROUND
  The role of staging laparoscopy (SL) with laparoscopic ultrasound (LUS) in patients with resectable colorectal liver metastases (CRLM) remains controversial.
  
  
  METHODS
  A meta-analysis of all studies (from 1998 to the present) on the effect of SL/LUS in patients with potentially resectable CRLM with respect to alteration in surgical management was performed.
  
  
  RESULTS
  Twelve studies satisfied the inclusion criteria. A total of 1,047 patients underwent SL/LUS. The true yield of SL/LUS for CRLM was 19% (95% confidence interval [CI], 16%-22%), with a diagnostic odds ratio of 132 (95% CI, 56-310) and an overall sensitivity of 59% (95% CI, 53%-65%). Subgroup analysis for detection of other liver and peritoneal lesions showed a sensitivity of 59% (95% CI, 49%-67%) and 75% (95% CI, 63%-85%) respectively. There was major between-study heterogeneity for all analyses, with no obvious cause revealed by meta-regression.
  
  
  CONCLUSIONS
  The true benefit of using SL/LUS universally seems limited. It appears more useful as an adjunct in patients when peritoneal disease is suspected.
authors.affiliation: Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK.
authors.forename: Deepak
authors.initials: D
authors.lastname: Hariharan
authors.forename: Vasilis
authors.initials: V
authors.lastname: Constantinides
authors.forename: Hemant M
authors.initials: HM
authors.lastname: Kocher
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
mesh_terms: D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D009367:Neoplasm Staging; D016017:Odds Ratio; D057234:Preoperative Period; D012680:Sensitivity and Specificity; D014465:Ultrasonics