2016/07/06 by Victoria B Allen, Kurinchi Selvan Gurusamy, Yemisi Takwoingi +2 · 1 citation
Medicine · #Pancreatic and Hepatic Oncology Research #Gallbladder and Bile Duct Disorders #Colorectal Cancer Screening and Detection
paper · pdf · doi:10.1002/14651858.cd009323.pub3
openalex publication_date 2016/07/06 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/25
Background<br/>Surgical resection is the only potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of<br/>patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT)<br/>scanning. Laparoscopy can detect metastases not visualised on CT scanning, enabling better assessment of the spread of cancer (staging<br/>of cancer). This is an update to a previous Cochrane Review published in 2013 evaluating the role of diagnostic laparoscopy in assessing<br/>the resectability with curative intent in people with pancreatic and periampullary cancer.<br/>Objectives<br/>To determine the diagnostic accuracy of diagnostic laparoscopy performed as an add-on test to CT scanning in the assessment of<br/>curative resectability in pancreatic and periampullary cancer.<br/>Search methods<br/>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, EMBASE via OvidSP (from<br/>inception to 15 May 2016), and Science Citation Index Expanded (from 1980 to 15 May 2016).<br/>Selection criteria<br/>We included diagnostic accuracy studies of diagnostic laparoscopy in people with potentially resectable pancreatic and periampullary<br/>cancer on CT scan, where confirmation of liver or peritoneal involvement was by histopathological examination of suspicious (liver or<br/>peritoneal) lesions obtained at diagnostic laparoscopy or laparotomy. We accepted any criteria of resectability used in the studies. We<br/>included studies irrespective of language, publication status, or study design (prospective or retrospective). We excluded case-control<br/>studies.<br/>Data collection and analysis<br/>Two review authors independently performed data extraction and quality assessment using the QUADAS-2 tool. The specificity of<br/>diagnostic laparoscopy in all studies was 1 because there were no false positives since laparoscopy and the reference standard are one<br/>and the same if histological examination after diagnostic laparoscopy is positive. The sensitivities were therefore meta-analysed using a<br/>univariate random-effects logistic regression model. The probability of unresectability in people who had a negative laparoscopy (posttest<br/>probability for people with a negative test result) was calculated using themedian probability of unresectability (pre-test probability)<br/>from the included studies, and the negative likelihood ratio derived from the model (specificity of 1 assumed). The difference between<br/>the pre-test and post-test probabilities gave the overall added value of diagnostic laparoscopy compared to the standard practice of CT<br/>scan staging alone.<br/>Main results<br/>We included 16 studies with a total of 1146 participants in the meta-analysis. Only one study including 52 participants had a low risk<br/>of bias and low applicability concern in the patient selection domain. The median pre-test probability of unresectable disease after CT<br/>scanning across studies was 41.4% (that is 41 out of 100 participants who had resectable cancer after CT scan were found to have<br/>unresectable disease on laparotomy). The summary sensitivity of diagnostic laparoscopy was 64.4% (95% confidence interval (CI)<br/>50.1% to 76.6%). Assuming a pre-test probability of 41.4%, the post-test probability of unresectable disease for participants with a<br/>negative test result was 0.20 (95% CI 0.15 to 0.27). This indicates that if a person is said to have resectable disease after diagnostic<br/>laparoscopy and CT scan, there is a 20% probability that their cancer will be unresectable compared to a 41% probability for those<br/>receiving CT alone.<br/>A subgroup analysis of people with pancreatic cancer gave a summary sensitivity of 67.9% (95% CI 41.1% to 86.5%). The post-test<br/>probability of unresectable disease after being considered resectable on both CT and diagnostic laparoscopy was 18% compared to<br/>40.0% for those receiving CT alone.<br/>Authors’ conclusions<br/>Diagnostic laparoscopy may decrease the rate of unnecessary laparotomy in people with pancreatic and periampullary cancer found<br/>to have resectable disease on CT scan. On average, using diagnostic laparoscopy with biopsy and histopathological confirmation of<br/>suspicious lesions prior to laparotomy would avoid 21 unnecessary laparotomies in 100 people in whom resection of cancer with<br/>curative intent is planned.<br/>