Diagnostic role of staging laparoscopy in a subset of biliary cancers: a meta‐analysis

Tian, Yunhong; Liu, Lei; Yeolkar, Ninad V.; Shen, Feng; Li, Jun; He, Zhenxing

doi:10.1111/ans.13762

Cited by 25 publications

(13 citation statements)

References 33 publications

(72 reference statements)

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“…6–24 Positive staging laparoscopy (SL) prevents unnecessary invasive operations that are associated with greater in-hospital mortality and prolonged length of stay. 9,25 Multiple reports demonstrate a uniformly poor prognosis in gastric cancer patients with peritoneal disease, leading the National Comprehensive Cancer Network (NCCN) to recommend pretreatment SL for patients with clinical stage IB or higher disease.…”

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confidence: 99%

The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation

et al. 2017

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Background Gastric cancer is a heterogeneous disease with variable presentation between racial and ethnic groups. Staging laparoscopy (SL) detects occult metastases not visible on cross-sectional imaging and therefore improves staging. It remains unclear how differences in race and ethnicity affect disease presentation and the yield of SL. Methods We performed a retrospective review of a prospectively maintained database to identify patients with gastric cancer treated with curative intent at our institutions from 2008 to 2015. Results Hispanic patients presented at an earlier mean age (55.5 ± 11.9 years) compared with Asian (59.8 ± 13.9 years), African American (61.0 ± 10.0 years), and white patients (61.7 ± 12.5 years; p = 0.046) and with more locally advanced disease (clinical stage T3/T4 or node positive; Hispanic 87%; African American 79%; white 68%, Asian 55%; p = 0.03). SL identified 42 patients (34%) with occult metastatic disease. Hispanics were more likely to have a positive SL (44%) than white patients (21%; p = 0.04). On univariate analysis, Hispanic ethnicity, clinical T3/T4, positive nodal disease, signet ring cells, and poor differentiation were predictors of a positive SL. On multivariable analysis, clinical T3/T4, signet ring cells, and poor differentiation independently predicted radiographically occult disease. Conclusions Hispanic patients presented with more locally advanced disease and were more likely to have occult disease found on SL compared with white patients. Laparoscopy should be used routinely as part of the pretreatment staging evaluation for patients with locally advanced disease as it alters the management in a significant proportion of patients.

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confidence: 99%

The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation

et al. 2017

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“…16 In a recent metaanalysis (2017) comprising eight studies and 1062 patients undergoing SL for biliary cancer, the yield in GBC and HC was found to be 27.6% and 32.4%, respectively. 17 In this study, we found that the utilization of SL for EHBT increased across 10 tertiary centers over the 15-year time period and was significantly higher in GBC than DC or HC. Yet, the yield of SL overall was modest in comparison to prior studies (16.8%) and did not significantly change over time or between biliary cancer subtypes.…”

Section: Resultsmentioning

confidence: 55%

“…The authors further suggested that improvements in SL could be made with the inclusion of laparoscopic ultrasound for deep parenchymal liver lesions and/or endoscopic or laparoscopic sampling of interaortocaval lymph nodes . In a recent meta‐analysis (2017) comprising eight studies and 1062 patients undergoing SL for biliary cancer, the yield in GBC and HC was found to be 27.6% and 32.4%, respectively …”

Section: Discussionmentioning

confidence: 99%

Staging laparoscopy among three subtypes of extra‐hepatic biliary malignancy: a 15‐year experience from 10 institutions

Davidson

Jin

Krasnick

et al. 2018

Journal of Surgical Oncology

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Background Staging laparoscopy (SL) is used to avoid resection failure and thus increase the curative resection rate. SL utilization in extra‐hepatic biliary tumors (EHBT) is variable. Methods Data from 1090 patients with potentially resectable EHBT including gallbladder (GBC), distal (DC), and hilar (HC) subtypes were retrospectively collected from 10 academic centers (2000‐2015). Results The SL utilization rate increased over time and was significantly higher in GBC than DC and HC. SL yield was 16.8% and did not differ between groups or over time. In patients undergoing attempted resection with prior SL, the curative resection rate did not differ between subtypes. In patients undergoing attempted resection without prior SL, the curative resection rate was less in GBC compared with DC or HC. After matching cohorts by inverse probability weighting, prior SL was associated with curative resection in GBC only (odds ratio [OR], 2.41, 95% CI, 1.36‐4.27). On multivariable regression analysis, elevated carbohydrate antigen 19‐9 (CA 19‐9), low serum albumin, and GBC were strong predictors of distant disease on SL. After categorizing patients undergoing SL into low, intermediate, and high‐risk groups based on these parameters, SL yield improved progressively from 10.0% to 19.6% to 52.6%. Conclusions We recommend routine SL for patients with GBC, particularly with elevated CA19‐9 level and/or decreased serum albumin.

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“…Although the relationship between the T stage of GBC and the beneit of diagnostic laparoscopy is not yet established in cholangiocarcinomas [37], most researchers suggest the use of diagnostic laparoscopy in patients with T2/3 lesions scheduled for reresection [38,39], in order to save them the burden of a full laparotomy. A recent meta-analysis found the accuracy of diagnostic laparoscopy to be 63.9% [40]. The sensitivity of diagnostic laparoscopy in GBC was 0.642 (95% CI: 0.579-0.7).…”

Section: Updates In Gallbladder Diseasesmentioning

confidence: 99%

Incidental Gallbladder Cancer

Al-Alem¹,

Mattar²,

Madkhali³

et al. 2017

Updates in Gallbladder Diseases

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Gallbladder cancer (GBC) is a rare but fatal disease with an incidence of less than 5000 new cases per year in the United States. Less than 20% of GBC cases are diagnosed preoperatively. The remaining cases are diagnosed either after laparoscopic cholecystectomy or intraoperatively. GBC is discovered incidentally during histopathology following 0.25-3.0% of laparoscopic cholecystectomies; however, this constitutes 74-92% of all GBC. The most pivotal and important step is accurate patient staging. Staging dictates disease management and treatment options and predicts survival. Because of the fatality of GBC and its poor prognosis, atempts of curative surgery are limited to localized resectable disease.

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Diagnostic role of staging laparoscopy in a subset of biliary cancers: a meta‐analysis

Abstract: 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.

Cited by 25 publications

References 33 publications

The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation

The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation

Staging laparoscopy among three subtypes of extra‐hepatic biliary malignancy: a 15‐year experience from 10 institutions

Incidental Gallbladder Cancer

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