Review
Staging laparoscopy in gastric cancer to detect peritoneal metastases: A systematic review and meta-analysis

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Abstract

Several imaging tests are used to stage gastric cancer; however the accuracy in the detection of peritoneal metastases is still low. Staging laparoscopy in gastric cancer has shown good results compared to imaging tests, particularly in patients with locally advanced disease signs. A search was conducted on electronic databases, and the studies were selected by methodological quality, inclusion and exclusion criteria. Data were analyzed using the Meta-Disc software version 1.4 to: describe primary results and explore homogeneity; explore threshold effect; calculate the sensitivity and specificity, negative and positive likelihood ratios; calculate the diagnostic odds ratio (DOR); and the summary ROC (sROC) curve. Five primary studies with a total of 240 participants were obtained. The overall sensitivity was 84.6%, and the overall specificity was 100%. The sensitivity and specificity homogeneity tests showed a Q value of 2.51 (P < 0.6434) with I2 = 0, and Q = 0% (P = 1.0), I2 = 0%, respectively. The DOR was 291.31 and positive and negative likelihood ratios were 0.197 and 49.711, respectively; while the AUC obtained by sROC was 98%. Staging laparoscopy shows good accuracy in the detection of peritoneal metastases and is an important diagnostic tool in the staging of gastric cancer.

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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