title: Diagnostic role of staging laparoscopy in a subset of biliary cancers: a meta-analysis.
abstract: BACKGROUND
  Accurate preoperative radiological staging of biliary cancers remains difficult. Despite the improvement in imaging techniques, a number of patients with biliary cancers who undergo laparotomy are ultimately found to have unresectable diseases. The goals of staging laparoscopy (SL) are to rule out metastatic and locally advanced unresectable diseases and better define locally advanced unresectable diseases. This study evaluates the efficiency of SL in ruling out unresectable disease in a subset of biliary cancers.
  
  
  METHODS
  Literature published between January 2000 and December 2015 on the use of SL for patients with biliary cancers was retrieved from five electronic databases. Summary estimates of sensitivity, specificity and diagnostic odds ratio were calculated.
  
  
  RESULTS
  Eight studies were included in the meta-analysis. During the laparoscopy, unresectable disease was found in 316 of 1062 patients (29.8%), of whom 32.4% were patients with suspected hilar cholangiocarcinoma (HC) and 27.6% were patients with suspected gallbladder cancer (GBC). The sensitivities were 0.556 (95% confidence interval (CI): 0.495-0.616) for patients with HC and 0.642 (95% CI: 0.579-0.701) for patients with GBC. The pooled specificity for the SL was 100% (95% CI: 0.993-1.000) for all studies.
  
  
  CONCLUSIONS
  This meta-analysis revealed that 32.4% of patients with HC and 27.6% of patients with GBC may avoid unnecessary laparotomy with the use of SL. It is worthwhile to perform SL combined with an intraoperative ultrasound in patients with suspected GBC or HC.
authors.affiliation: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Soochow University, Suzhou, China.|Department of Hepato-Biliary Surgery, Nanchong Central Hospital, Nanchong, China.|Graduate School of Soochow University, Suzhou, China.
authors.forename: Yunhong
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Graduate School of Soochow University, Suzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.affiliation: Graduate School of Soochow University, Suzhou, China.
authors.forename: Ninad V
authors.initials: NV
authors.lastname: Yeolkar
authors.affiliation: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Soochow University, Suzhou, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
authors.affiliation: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Soochow University, Suzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Hepato-Biliary Surgery, Nanchong Central Hospital, Nanchong, China.
authors.forename: Zhenxing
authors.initials: Z
authors.lastname: He
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods*; D057234:Preoperative Period
keywords: gallbladder cancer; hilar cholangiocarcinoma; laparoscopy; staging