ReviewStaging laparoscopy in gastric cancer to detect peritoneal metastases: A systematic review and meta-analysis
Introduction
Nearly one million new cases of gastric cancer were estimated to have occurred in 2012, becoming the fifth most common malignancy and the second in cancer mortality in the world.1 It is estimated that in Brazil it is the third malignancy in incidence in men and the fifth in women, with 12,870 new cases in men and 7520 in women in the year 2014.2
Gastric cancer has poor prognosis, and the ratio mortality/incidence is considered high worldwide. This is because these tumors are diagnosed in advanced stages, with only 50% of patients being candidates for curative treatment at diagnosis.2
Several imaging methods are employed in the staging of gastric cancer. A recent meta-analysis showed that computed tomography (CT) has good accuracy in staging gastric cancer, but the detection of peritoneal metastases has still low sensitivity and specificity.3
The staging laparoscopy for gastric cancer has been used, in particular, in patients with locally advanced disease, candidates for neoadjuvant therapy and peritoneal implants suspected.4 Besides being more accurate in the detection of peritoneal metastases compared with imaging tests,5 it avoids unnecessary laparotomies.6
Although several studies have demonstrated the superiority of laparoscopy over conventional imaging tests for detection of peritoneal metastases,7, 8 the scientific evidence on this issue remains uncertain, since most of those studies have low methodological quality as well as excessively small samples.
The aim of this study is to bring more scientific evidence on this issue through a systematic review and meta-analysis of studies related to diagnostic tests in patients undergoing laparoscopy for staging of gastric cancer.
Section snippets
Information sources and search
The search for scientific articles was performed in the databases MEDLINE, LILACS, and EMBASE, using the terms “Stomach Neoplasms (MeSH)”, “Neoplasm Staging (MeSH)”, and “Laparoscopy (MeSH)”. There were no language nor publication date limitations.
Criteria for inclusion and exclusion
The inclusion criterion was studies of diagnostic test and accuracy in laparoscopic staging of gastric cancer confirmed by histopathologic examination with evaluation for possible peritoneal metastases. The exclusion criteria were studies that used no
Eligible studies
Using search strategy in electronic databases and manual search, 377 articles were retrieved, of which 107 were selected only by title assessment. Based on the abstracts of such 107 articles, 44 were selected and read in full. Then, after inclusion and exclusion criteria, only 12 articles were considered. Finally, after qualitative analysis for the methodology applied, only five primary studies were kept.6, 13, 14, 15, 16 The diagram flow of the article analyses is presented in Fig. 1. The
Discussion
Gastric cancer remains one of the most prevalent and lethal malignancies worldwide, especially due to the difficulty of diagnosis at earlier stages. Consequently a little over 50% of these patients are candidates for curative treatment at the time of diagnosis. Computed tomography (CT) with contrast is the imaging modality of choice for preoperative staging. A recent meta-analysis3 demonstrated that CT is a good test to assess the local extension and the presence of distant metastases, but it
Conflict of interest statement
None.
Financial support
None.
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